Mattioli S, D'Ovidio F, Di Simone M P, Bassi F, Brusori S, Pilotti V, Felice V, Ferruzzi L, Guernelli N
Center for the Study and Therapy of Diseases of the Esophagus of the University of Bologna, Italy.
J Thorac Cardiovasc Surg. 1998 Aug;116(2):267-75. doi: 10.1016/s0022-5223(98)70126-6.
The pathophysiologic influence of progressive intrathoracic migration of the gastroesophageal junction axial to the esophagus on gastroesophageal reflux disease was investigated.
A radiologic-manometric study was performed on hiatal insufficiency, concentric hiatus hernia, and short esophagus, the three radiologic steps of intrathoracic gastroesophageal junction migration, and on healthy volunteers. The distances between inferior and superior margins of the lower esophageal sphincter and the diaphragm were measured. Endoscopic, manometric, and pH-metric evaluations were performed after barium swallow in 38 patients with severe gastroesophageal reflux disease and sliding hiatus hernia with intraabdominally reducible gastroesophageal junction, in 35 patients with hiatal insufficiency, in 40 with concentric hiatus hernia, and in 19 with short esophagus.
The distance from the lower esophageal sphincter inferior margin to the diaphragm was different in healthy volunteers (-2.6 +/- 0.9 cm [standard deviation]) versus that in patients with hiatal insufficiency (-1.0 +/- 0.7 cm; p = 0.02), concentric hiatus hernia (-0.8 +/- 1.0 cm; p = 0.02), and short esophagus (4.0 +/- 2.5 cm; p = 0.0002), and in patients with short esophagus versus hiatal insufficiency (p = 0.0002) and concentric hiatus hernia (p = 0.0002). Lower esophageal sphincter tone was reduced between healthy volunteers (19 +/- 9.1 mm Hg [standard deviation]) and patients with sliding hiatus hernia (12 +/- 7.2 mm Hg;p = 0.02), hiatal insufficiency (10 +/- 5.9 mm Hg; p = 0.0001), concentric hiatus hernia (7 +/- 3.1 mm Hg; p = 0.00002), and short esophagus (7 +/- 3.7 mm Hg; p = 0.00003) and between concentric hiatus hernia versus sliding hiatus hernia (p = 0.007). Acid gastroesophageal reflux total time percent was increased between healthy volunteers (2.4% +/- 1.8% [standard deviation]) and patients with sliding hiatus hernia (12.8% +/- 7.8%;p = 0.02), hiatal insufficiency (17.2% +/- 15.8%; p = 0.0001), concentric hiatus hernia (24.0% +/- 19.6%;p = 0.00002), and short esophagus (26.1% +/- 19.6%;p = 0.00002) and between sliding hiatus hernia versus concentric hiatus hernia (p = 0.002) and short esophagus (p = 0.01).
Permanent gastroesophageal junction orad migration axial to the esophagus has greater pathophysiologic relevance on gastroesophageal reflux disease than sliding hiatus hernia with an intraabdominally reducible gastroesophgeal junction. Hiatal insufficiency, concentric hiatus hernia, and short esophagus are markers of progressively increasing irreversible cardial incontinence and therefore indications for surgical therapy.
研究胃食管交界轴向食管进行性胸内移位对胃食管反流病的病理生理影响。
对食管裂孔功能不全、同心性食管裂孔疝和短食管（胸内胃食管交界移位的三个放射学阶段）以及健康志愿者进行放射学-测压研究。测量食管下括约肌上下边缘与膈肌之间的距离。对38例患有严重胃食管反流病且伴有可腹内回纳的胃食管交界的滑动型食管裂孔疝患者、35例食管裂孔功能不全患者、40例同心性食管裂孔疝患者和19例短食管患者进行了吞钡后的内镜、测压和pH值测量评估。
健康志愿者食管下括约肌下缘至膈肌的距离（-2.6±0.9厘米[标准差]）与食管裂孔功能不全患者（-1.0±0.7厘米；p = 0.02）、同心性食管裂孔疝患者（-0.8±1.0厘米；p = 0.02）和短食管患者（4.0±2.5厘米；p = 0.0002）不同，短食管患者与食管裂孔功能不全患者（p = 0.0002）和同心性食管裂孔疝患者（p = 0.0002）也不同。健康志愿者（19±9.1毫米汞柱[标准差]）与滑动型食管裂孔疝患者（12±7.2毫米汞柱；p = 0.02）、食管裂孔功能不全患者（10±5.9毫米汞柱；p = 0.0001）、同心性食管裂孔疝患者（7±3.1毫米汞柱；p = 0.00002）和短食管患者（7±3.7毫米汞柱；p = 0.00003）之间食管下括约肌张力降低，同心性食管裂孔疝与滑动型食管裂孔疝之间（p = 0.007）也降低。健康志愿者（2.4%±1.8%[标准差]）与滑动型食管裂孔疝患者（12.8%±7.8%；p = 0.02）、食管裂孔功能不全患者（17.2%±15.8%；p = 0.0001）、同心性食管裂孔疝患者（24.0%±19.6%；p = 0.00002）和短食管患者（26.1%±19.6%；p = 0.00002）之间酸性胃食管反流总时间百分比增加，滑动型食管裂孔疝与同心性食管裂孔疝之间（p = 0.002）和短食管之间（p = 0.01）也增加。
胃食管交界相对于食管的永久性向心性移位对胃食管反流病的病理生理影响比伴有可腹内回纳的胃食管交界的滑动型食管裂孔疝更大。食管裂孔功能不全、同心性食管裂孔疝和短食管是进行性增加的不可逆贲门失禁的标志，因此是手术治疗的指征。
