Penagini R, Schoeman M N, Dent J, Tippett M D, Holloway R H
Royal Adelaide Hospital, South Australia.
Neurogastroenterol Motil. 1996 Jun;8(2):131-41. doi: 10.1111/j.1365-2982.1996.tb00253.x.
Information on the mechanism of gastro-oesophageal reflux in patients with reflux disease is limited largely to studies in resting recumbent subjects. Evidence exists that both posture and physical activity may influence reflux. The aim of this study was to investigate reflux mechanisms in ambulant patients with reflux oesophagitis. Concurrent ambulatory oesophageal manometry and pH monitoring were performed in 11 ambulant patients with erosive oesophagitis. Lower oesophageal sphincter (LOS) pressure was monitored with a perfused sleeve sensor. Recordings were made for 90 min before and 180 min after a meal. At set times patients sat in a chair or walked. LOS pressure was < or = 2 mmHg at the time of reflux for 98% of reflux episodes. Transient LOS relaxation was the most common pattern overall and the predominant pattern in seven patients, whilst persistently absent basal LOS pressure was the most common pattern in four patients. The pattern of LOS pressure was not altered by the presence of hiatus hernia or by walking. Straining occurred at the onset of 31% of acid reflux episodes but often followed the development of an oesophageal common cavity. The occurrence of straining was not influenced by walking. In ambulant patients with reflux oesophagitis: (1) LOS pressure is almost always absent at the time of reflux, usually because of transient LOS relaxation, (2) persistently absent basal LOS pressure is an important mechanism of reflux in a few patients, (3) straining may help to induce acid reflux in a variable proportion of occasions and may in some instances be a response to gas reflux, and (4) walking does not influence the occurrence of reflux or its mechanisms.
关于反流性疾病患者胃食管反流机制的信息在很大程度上仅限于对静卧受试者的研究。有证据表明，姿势和体力活动都可能影响反流。本研究的目的是调查活动性反流性食管炎患者的反流机制。对11例活动性糜烂性食管炎患者同时进行动态食管测压和pH监测。用灌注袖套传感器监测食管下括约肌（LOS）压力。在进食前90分钟和进食后180分钟进行记录。在设定时间，患者坐在椅子上或行走。98%的反流发作时，反流发生时LOS压力≤2 mmHg。总体而言，短暂LOS松弛是最常见的模式，7例患者中占主导地位，而4例患者中持续缺乏基础LOS压力是最常见的模式。LOS压力模式不受食管裂孔疝的存在或行走的影响。31%的酸反流发作开始时会出现用力，但通常在食管共同腔形成后出现。用力的发生不受行走的影响。在活动性反流性食管炎患者中：（1）反流发生时LOS压力几乎总是不存在，通常是由于短暂LOS松弛；（2）持续缺乏基础LOS压力是少数患者反流的重要机制；（3）用力在不同比例的情况下可能有助于诱发酸反流，在某些情况下可能是对气体反流的反应；（4）行走不影响反流的发生及其机制。
