D'Onofrio V, Bovero E, Iaquinto G
Service of Gastroenterology and Endoscopy, San G. Moscati Hospital, Avellino, Italy.
Dis Esophagus. 1997 Jan;10(1):16-22; discussion 22-3.
Although the pathogenic role of gastroesophageal reflux in Barrett's esophagus is widely accepted, the pattern of gastric and esophageal pH profile of patients with Barrett's esophagus is not well documented. Moreover, the observation that a columnar-lined esophagus can also develop after gastrectomy implies that chronic irritation of the lower esophagus by duodenal juice can be as harmful as acid reflux. To test this hypothesis, we simultaneously monitored gastric and esophageal pH in 19 patients with endoscopically and histologically proven Barrett's esophagus, in 35 with slight-to-moderate esophagitis and in 10 healthy subjects. The gastroesophageal reflux pattern in both Barrett's esophagus and esophagitis was characterized by mainly acid refluxes. Esophageal acid exposure (% time pH < 4) was 39.4 in patients with Barrett's esophagus, 14.6 in patients with esophagitis (P < 0.05), and 3.1 in healthy subjects (P < 0.05). Seven of 19 patients with Barrett's esophagus and 7 of 35 with esophagitis had evidence of alkaline reflux too; but pure alkaline refluxes accounted for only 1.9% of total time in Barrett's esophagus and 0.3% in esophagitis patients. In conclusion, these results confirm the high prevalence and severity of acid reflux in patients with Barrett's esophagus and show that the reflux of pure alkaline material into the esophagus is a rare event in both Barrett's esophagus and esophagitis patients.
尽管胃食管反流在巴雷特食管中的致病作用已被广泛接受，但巴雷特食管患者的胃和食管pH值变化模式尚无充分记录。此外，胃切除术后也可出现柱状上皮化生食管这一现象表明，十二指肠液对食管下段的慢性刺激可能与酸反流一样有害。为验证这一假设，我们对19例经内镜和组织学证实为巴雷特食管的患者、35例轻至中度食管炎患者及10名健康受试者同时进行了胃和食管pH值监测。巴雷特食管和食管炎患者的胃食管反流模式均以酸反流为主。巴雷特食管患者的食管酸暴露（pH<4的时间百分比）为39.4%，食管炎患者为14.6%（P<0.05），健康受试者为3.1%（P<0.05）。19例巴雷特食管患者中有7例，35例食管炎患者中有7例也有碱性反流的证据；但在巴雷特食管患者中，单纯碱性反流仅占总时间的1.9%，在食管炎患者中占0.3%。总之，这些结果证实了巴雷特食管患者中酸反流的高发生率和严重性，并表明单纯碱性物质反流至食管在巴雷特食管和食管炎患者中均属罕见。
