Achem S R, Kolts B E, Wears R, Burton L, Richter J E
Department of Medicine, University of Florida Health Science Center, Jacksonville.
Am J Gastroenterol. 1993 Feb;88(2):187-92.
A review of our 402 motility records of patients undergoing evaluation of noncardiac chest pain identified 40 patients with the diagnosis of nutcracker esophagus. Gastroesophageal reflux was found in 13 of 20 patients (65%) who underwent pH studies, and endoscopy detected one patient with erosive esophagitis. Thus, at least 14 (35%) of our nutcracker esophagus patients had evidence of reflux. Twelve of these subjects agreed to enter an open-label therapeutic trial. After 8 wk of intensive antireflux treatment with high doses of ranitidine or omeprazole, repeat 24-h pH studies and endoscopy demonstrated normalization of pH parameters and healing of esophagitis in all patients. Ten (83%) patients obtained significant symptomatic improvement in frequency of pain episodes, number of days with pain, and pain severity. However, repeat manometry showed normalization of motor findings in only two (18%) patients. These observations warrant further placebo-controlled trials. Until more information is available, the results of this study suggest that gastroesophageal reflux should be excluded in patients with noncardiac chest pain and nutcracker esophagus before initiation of smooth muscle relaxant therapy.
对402例接受非心源性胸痛评估患者的运动功能记录进行回顾，发现40例诊断为胡桃夹食管的患者。在接受pH值研究的20例患者中，13例（65%）发现胃食管反流，内镜检查发现1例糜烂性食管炎患者。因此，我们的胡桃夹食管患者中至少14例（35%）有反流证据。其中12名受试者同意参加开放标签治疗试验。在用高剂量雷尼替丁或奥美拉唑进行8周强化抗反流治疗后，重复24小时pH值研究和内镜检查显示所有患者的pH值参数正常化且食管炎愈合。10例（83%）患者在疼痛发作频率、疼痛天数和疼痛严重程度方面有显著症状改善。然而，重复测压仅显示2例（18%）患者的运动功能结果正常化。这些观察结果需要进一步的安慰剂对照试验。在获得更多信息之前，本研究结果表明，在开始平滑肌松弛剂治疗之前，应排除非心源性胸痛和胡桃夹食管患者的胃食管反流。
