Marshall R E, Anggiansah A, Owen W A, Owen W J
Department of Surgery, Guy's Hospital, London SE1 9RT, UK.
Eur J Gastroenterol Hepatol. 1998 May;10(5):385-92. doi: 10.1097/00042737-199805000-00006.
Damage caused to oesophageal mucosa by bile constituents is pH dependent. The aim of this study was to evaluate the relationship between pH and duodeno-gastro-oesophageal reflux in gastro-oesophageal reflux disease at night in the supine position.
A prospective study of 113 patients with reflux symptoms [63 without erosive oesophagitis (group 1), 23 with erosive oesophagitis (group 2), 27 Barrett's oesophagus (group 3)] and 15 controls.
All subjects underwent 24 h ambulatory oesophageal pH and bilirubin and gastric pH monitoring. For the supine period, oesophageal pH during episodes of bile reflux was calculated, and the temporal relationship between individual oesophageal and gastric alkaline shift and oesophageal bile reflux episodes was established. The supine period was divided into four equal segments and the temporal patterns of acid and bile reflux and alkaline shift in each of the four supine time segments were investigated.
Both acid and bile reflux are severe in Barrett's oesophagus, particularly at night. Nocturnal oesophageal bile reflux occurs mostly between pH 4 and 7 in all groups: 67.6%, 76.5% and 41.4% of the supine period for groups 1, 2 and 3 respectively (P < 0.001 vs. pH < 4 or > 7). Individual oesophageal bile reflux and oesophageal or gastric alkaline shift episodes rarely coincide. Acid reflux predominates in the first half of the night (P < 0.001), oesophageal bile reflux and alkaline shift continue throughout the night, gastric alkaline shift increases towards the end of the night (P < 0.001).
Duodenal contents in the oesophagus exist at a wide pH range, and may have passed through an acid or an alkaline stomach. This has implications for the damage which individual constituents are able to cause.
胆汁成分对食管黏膜造成的损伤取决于pH值。本研究旨在评估仰卧位夜间胃食管反流病中pH值与十二指肠-胃-食管反流之间的关系。
对113例有反流症状的患者[63例无糜烂性食管炎（第1组），23例有糜烂性食管炎（第2组），27例巴雷特食管（第3组）]和15例对照者进行前瞻性研究。
所有受试者均接受24小时动态食管pH值、胆红素及胃pH值监测。对于仰卧期，计算胆汁反流发作期间的食管pH值，并确定个体食管和胃碱性转变与食管胆汁反流发作之间的时间关系。将仰卧期分为四个相等的时间段，研究四个仰卧时间段中每个时间段的酸和胆汁反流以及碱性转变的时间模式。
巴雷特食管中酸和胆汁反流均很严重，尤其是在夜间。所有组夜间食管胆汁反流大多发生在pH值4至7之间：第1组、第2组和第3组分别占仰卧期的67.6%、76.5%和41.4%（与pH值<4或>7相比，P<0.001）。个体食管胆汁反流与食管或胃碱性转变发作很少同时发生。酸反流在夜间前半段占主导（P<0.001），食管胆汁反流和碱性转变在整个夜间持续存在，胃碱性转变在夜间快结束时增加（P<0.001）。
食管中的十二指肠内容物存在于较宽的pH值范围内，可能已经经过酸性或碱性的胃。这对各个成分可能造成的损伤具有影响。
