Kasapidis P, Vassilakis J S, Tzovaras G, Chrysos E, Xynos E
Department of Gastroenterology, Athens Naval and Veterans Hospital, Heraklion, Greece.
Dig Dis Sci. 1995 Dec;40(12):2724-30. doi: 10.1007/BF02220466.
An increased frequency of reflux events and a prolonged acid clearance have been shown in gastroesophageal reflux (GER) patients with a hiatal hernia as compared to those without. The objective of the present study was to further investigate esophageal motility and patterns of reflux in GER patients, in relation to the presence or absence of hiatal hernia. Esophageal manometry and ambulatory 24-hr esophageal pH-metry were used in 42 patients with GER and 18 controls. Eighteen of the patients were considered to have a nonreducing hiatal hernia on endoscopy. Hiatal hernia patients showed a higher extent of reflux (total composite score, P = 0.016; total reflux time, P = 0.008, reflux time in supine position, P = 0.024; reflux time in upright position, P = 0.008), a lower frequency of reflux events (P = 0.005), a more severe esophagitis on endoscopy (P < 0.01) and a lower amplitude of peristalsis at 5 cm proximal to LES (P = 0.0009) as compared to patients without hiatal hernia. The amplitude of peristalsis at the distal esophagus was inversely related to the extent of reflux (P = 0.024). Acid clearance was also significantly prolonged in the hernia subgroup (P = 0.011). Although LES resting pressure did not differ significantly between the two subgroups of patients, it was inversely related to the extent of reflux in the patients with hiatal hernia (P = 0.0005). It is concluded, that GER patients with hiatal hernia present with an increased amount of reflux and more severe esophagitis, which results in more severely impaired esophageal peristalsis as compared to patients without hernia. Prolonged acid clearance and impaired esophageal emptying observed in patients with hiatal hernia could be the result of both the presence of the hernia itself and the reduced peristaltic activity of the esophagus.
与无食管裂孔疝的胃食管反流（GER）患者相比，有食管裂孔疝的GER患者反流事件频率增加，酸清除时间延长。本研究的目的是进一步研究GER患者食管动力及反流模式与有无食管裂孔疝的关系。对42例GER患者和18例对照者进行了食管测压和24小时动态食管pH监测。其中18例患者经内镜检查被认为有不可复位性食管裂孔疝。与无食管裂孔疝的患者相比，有食管裂孔疝的患者反流程度更高（总综合评分，P = 0.016；总反流时间，P = 0.008；仰卧位反流时间，P = 0.024；直立位反流时间，P = 0.008），反流事件频率更低（P = 0.005），内镜下食管炎更严重（P < 0.01），LES近端5 cm处蠕动幅度更低（P = 0.0009）。食管远端蠕动幅度与反流程度呈负相关（P = 0.024）。疝亚组的酸清除时间也显著延长（P = 0.011）。虽然两组患者的LES静息压无显著差异，但在有食管裂孔疝的患者中，LES静息压与反流程度呈负相关（P = 0.0005）。研究得出结论，与无疝患者相比，有食管裂孔疝的GER患者反流量增加，食管炎更严重，导致食管蠕动受损更严重。食管裂孔疝患者酸清除时间延长和食管排空受损可能是疝本身的存在以及食管蠕动活性降低共同作用的结果。
