贲门失弛缓症患者的食管张力

Oesophageal tone in patients with achalasia.

作者信息

González M, Mearin F, Vasconez C, Armengol J R, Malagelada J R

机构信息

Digestive System Research Unit, Hospital General Vall d'Hebron, Autonomous University of Barcelona, Spain.

出版信息

Gut. 1997 Sep;41(3):291-6. doi: 10.1136/gut.41.3.291.

DOI:10.1136/gut.41.3.291

PMID:9378380

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC1891480/

Abstract

BACKGROUND

The diagnosis and classification of oesophageal motility disorders is currently based on assessment of the phasic contractile activity of the oesophagus. Tonic muscular contraction of the oesophageal body (oesophageal tone) has not been well characterised.

AIM

To quantify oesophageal tonic activity in healthy subjects and in patients with achalasia.

PATIENTS

Oesophageal tone was measured in 14 patients with untreated achalasia and in 14 healthy subjects. In eight patients with achalasia, oesophageal tone was again measured one month after either endoscopic or surgical treatment.

METHODS

Tonic wall activity was quantified by means of a flaccid intraoesophageal bag, 5 cm long and of 120 ml maximal capacity, which was placed and maintained 5 cm above the lower oesophageal sphincter and connected to an external electronic barostat. The experimental design included measurement of oesophageal basal tone and compliance as well as the oesophageal tone response to a nitric oxide donor (0.5 ml amyl nitrite inhalation).

RESULTS

Oesophageal basal tone, expressed as the intrabag (intraoesophageal) volume at a minimal distending pressure (2 mm Hg), did not differ significantly between patients with achalasia and healthy controls (6.6 (2.5) ml versus 4.1 (0.8) ml, respectively). Oesophageal compliance (volume/pressure relation during intraoesophageal distension) was significantly increased in achalasia (oesophageal extension ratio: 3.2 (0.4) ml/mm Hg versus 1.9 (0.2) ml/mm Hg; p < 0.01). Amyl nitrite inhalation induced oesophageal relaxation both in patients and in controls, but the magnitude of relaxation was greater in the latter (intrabag volume increase: 15.3 (2.4) ml versus 36.2 (7.1) ml; p < 0.01).

CONCLUSION

In patients with achalasia, oesophageal tonic activity, and not only phasic activity, is impaired. Although oesophageal compliance is increased, residual oesophageal tone is maintained so that a significant relaxant response may occur after pharmacological stimulation.

摘要

背景

目前食管动力障碍的诊断和分类基于对食管阶段性收缩活动的评估。食管体部的紧张性肌肉收缩（食管张力）尚未得到充分表征。

目的

量化健康受试者和贲门失弛缓症患者的食管紧张性活动。

患者

对14例未经治疗的贲门失弛缓症患者和14例健康受试者测量食管张力。在8例贲门失弛缓症患者中，在内镜或手术治疗1个月后再次测量食管张力。

方法

通过一个柔软的食管内气囊来量化食管壁的紧张性活动，气囊长5 cm，最大容量为120 ml，放置在食管下括约肌上方5 cm处并保持该位置，连接到外部电子恒压器。实验设计包括测量食管基础张力和顺应性，以及食管对一氧化氮供体（吸入0.5 ml亚硝酸异戊酯）的张力反应。

结果

以最小扩张压力（2 mmHg）时气囊内（食管内）体积表示的食管基础张力，在贲门失弛缓症患者和健康对照之间无显著差异（分别为6.6（2.5）ml和4.1（0.8）ml）。贲门失弛缓症患者的食管顺应性（食管扩张期间的体积/压力关系）显著增加（食管伸展率：3.2（0.4）ml/mmHg对1.9（0.2）ml/mmHg；p<0.01）。亚硝酸异戊酯吸入在患者和对照组中均引起食管松弛，但后者的松弛幅度更大（气囊内体积增加：15.3（2.4）ml对36.2（7.1）ml；p<0.