Sevilla Mantilla M C, Ruiz de León A, Pérez de la Serna J, Taxonera C, García Paredes J, Díaz Rubio M
Service of Digestive Diseases, San Carlos University Hospital, Madrid, Spain.
Rev Esp Enferm Dig. 1998 Mar;90(3):145-54.
To define the relationship between esophageal dysmotility and severity of gastroesophageal reflux (GER) at the distal and proximal levels.
Two-level, 24-hour ambulatory pH monitoring and manometry of the esophagus were performed in 40 patients with abnormal distal acid exposure and in 20 healthy controls. Twenty patients with normal endoscopy or endoscopic evidence of grade I esophagitis were assigned to group 1 and 20 with grade II-III esophagitis were assigned to group 2. We used a dual-site pH probe with antimony electrodes spaced 15 cm apart.
Patients had greater acid exposure than controls at both levels. The percentage of distal reflux episodes reaching proximal esophagus was significantly greater in group 1 than in the control group. The most marked reductions in the percentage of time of the pH remaining under 4 were detected in the patients with the most severe distal acid reflux and esophagitis (group 2). The mean lower esophageal sphincter pressure was significantly lower in group 2 than in group 1. The percentage of tertiary waves or nonperistaltic contractions was significantly higher in group 2 than in group 1 and the control group. Patients with milder distal reflux had significantly lower distal and middle esophageal wave amplitudes than controls. There were no significant differences between controls and patients with severe esophagitis in terms of the esophageal peristaltic wave amplitude in the middle third of the esophagus.
No correlation was observed between episodes of distal reflux and proximal reflux in GER patients. Esophageal motor activity appears to be an important determinant of the severity and extension of GER in the proximal esophagus.
确定食管运动功能障碍与远端和近端胃食管反流（GER）严重程度之间的关系。
对40例远端酸暴露异常患者和20例健康对照者进行两级24小时动态pH监测和食管测压。20例内镜检查正常或有I级食管炎内镜证据的患者被分配到第1组，20例有II - III级食管炎的患者被分配到第2组。我们使用了间隔15 cm的带有锑电极的双位点pH探头。
患者在两个水平的酸暴露均高于对照组。第1组远端反流发作到达近端食管的百分比显著高于对照组。在远端酸反流和食管炎最严重的患者（第2组）中，pH值低于4的时间百分比下降最为明显。第2组食管下括约肌平均压力显著低于第1组。第2组的第三波或非蠕动性收缩百分比显著高于第1组和对照组。远端反流较轻的患者远端和食管中段波幅显著低于对照组。在食管中段三分之一处，对照组与重度食管炎患者的食管蠕动波幅无显著差异。
GER患者中未观察到远端反流发作与近端反流之间的相关性。食管运动活动似乎是近端食管GER严重程度和范围的重要决定因素。
