Benini L, Sembenini C, Castellani G, Bardelli E, Brentegani M T, Giorgetti P, Vantini I
Department of Gastroenterology, Rehabilitation Hospital of Valeggio sM, University of Verona, Italy.
Dig Dis Sci. 1996 Feb;41(2):365-71. doi: 10.1007/BF02093830.
Endoscopy, esophageal manometry and pH monitoring, gastric emptying test, and heartburn quantification on a visual analog scale were performed in 22 achalasic patients in order to clarify which events are associated with pathological esophageal acidification after successful LES dilatation. Five patients presented pathological acidification. Dilatation reduced LES tone from 38.3 +/- 4.2 to 14.6 +/- 1.1 mm Hg (mean +/- SEM); there was, however, no difference between nonrefluxers and refluxers (14.8 +/- 1.2 vs 13.8 +/- 2.5 mm Hg). The emptying time in achalasic patients was delayed compared to controls (315.9 +/- 20.9 min vs 209 +/- 10.4) due to prolonged lag-phase and reduced slope of the antral section-time curve, but, again, there was no difference between refluxers and nonrefluxers. The acid clearance was delayed in refluxers compared to nonrefluxers (15.9 +/- 4.5 vs 2.5 +/- 1.8 min, P<0.05). Two refluxers presented grade 1 esophagitis; one of them developed an esophageal ulcer. The heartburn score was the same in refluxers and nonrefluxers. Pathological acidification after pneumatic dilatation is associated with persistent problems in esophageal emptying rather than with excessive sphincter divulsion.
对22例贲门失弛缓症患者进行了内镜检查、食管测压和pH监测、胃排空试验以及采用视觉模拟评分法进行烧心量化，以明确哪些事件与LES扩张成功后病理性食管酸化相关。5例患者出现病理性酸化。扩张使LES压力从38.3±4.2降至14.6±1.1 mmHg（均值±标准误）；然而，非反流者和反流者之间并无差异（14.8±1.2 vs 13.8±2.5 mmHg）。与对照组相比，贲门失弛缓症患者的排空时间延迟（315.9±20.9分钟 vs 209±10.4分钟），原因是胃窦部时间曲线的延迟相延长和斜率降低，但反流者和非反流者之间同样无差异。与非反流者相比，反流者的酸清除延迟（15.9±4.5 vs 2.5±1.8分钟，P<0.05）。2例反流者出现1级食管炎；其中1例发生了食管溃疡。反流者和非反流者的烧心评分相同。气囊扩张后病理性酸化与食管排空持续存在问题相关，而非与括约肌过度撕裂相关。
