Park H J, Lee J D, Jung J K, Moon B S, Collins P J, Park I S
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
Yonsei Med J. 1996 Aug;37(4):278-83. doi: 10.3349/ymj.1996.37.4.278.
The purpose of this research was to investigate functional studies by which the hiatal hernia (HH) may be relevant to a reflux esophagitis (RE). Group I consisted of healthy controls who were endoscopically normal (n = 21). Group II consisted of patients with hiatal hernia but no reflux esophagitis (n = 8). Group III had patients with hiatal hernia with reflux esophagitis (n = 9). Group IV had patients with reflux esophagitis but no hiatal hernia (n = 16). Esophageal manometry, ambulatory 24 hour intraesophageal pH monitoring, acid clearance test, and gastric emptying scan were performed in each of the patients. The contraction amplitude at 3 cm above the lower esophageal sphincter did not differ significantly among the four groups, but the mean lower esophageal sphincter pressure was significantly decreased in group II. The DeMeester score in ambulatory 24 hour intraesophageal pH monitoring was significantly higher in group III compared with the controls. No significant difference among the groups was found with respect to acid clearance. Total and proximal gastric emptying times (T1/2) were significantly delayed in group III. We found that hiatal hernia combined with delayed gastric emptying may bear a relationship to the multifactorial origins of reflux esophagitis, and we suggest a rationale for using prokinetic agents as the therapeutic regimen in patients with HH complicated by RE.
本研究的目的是调查食管裂孔疝（HH）可能与反流性食管炎（RE）相关的功能研究。第一组由内镜检查正常的健康对照者组成（n = 21）。第二组由患有食管裂孔疝但无反流性食管炎的患者组成（n = 8）。第三组为患有食管裂孔疝合并反流性食管炎的患者（n = 9）。第四组为患有反流性食管炎但无食管裂孔疝的患者（n = 16）。对每位患者进行了食管测压、24小时动态食管pH监测、酸清除试验和胃排空扫描。食管下括约肌上方3 cm处的收缩幅度在四组之间无显著差异，但第二组的平均食管下括约肌压力显著降低。与对照组相比，第三组24小时动态食管pH监测中的DeMeester评分显著更高。各组之间在酸清除方面未发现显著差异。第三组的总胃排空时间和近端胃排空时间（T1/2）显著延迟。我们发现食管裂孔疝合并胃排空延迟可能与反流性食管炎的多因素起源有关，并且我们提出了在合并反流性食管炎的食管裂孔疝患者中使用促动力药物作为治疗方案的理论依据。
