Iovino P, Ciacci C, Sabbatini F, Acioli D M, D'Argenio G, Mazzacca G
Gastroenterology Unit, School of Medicine, Federico II University, Naples, Italy.
Am J Gastroenterol. 1998 Aug;93(8):1243-9. doi: 10.1111/j.1572-0241.1998.00403.x.
A high prevalence of reflux esophagitis in celiac children and gut motor disorders in adult patients have been described. The aim of this study is to investigate the prevalence of esophageal symptoms and the esophageal motility pattern in adult celiac patients before and after gluten-free diet.
In 22 consecutive adult celiac patients, before and after gluten-free diet, and in controls we calculated an esophageal symptom score regarding heartburn, regurgitation, dysphagia, and chest pain, and performed esophageal manometry using a constantly perfused multilumen catheter.
Patients were divided into two groups: with and without steatorrhea. Before gluten-free diet, the prevalence of esophageal symptoms was 45.5 % in all patients, but was significantly higher in patients with steatorrhea than in those without and in 44 control subjects (80% vs 16.7% and 27%, p < 0.05). Lower esophageal sphincter pressure was 17.5+/-5.3 in all patients, but was significantly lower in patients with steatorrhea than in patients without steatorrhea and 11 controls subjects (13.1+/-4.1 vs 21.0+/-2.9 and 20.7+/-3.7 mm Hg (mean+/-SD, p < 0.05). After the diet, the prevalence of esophageal symptoms diminished in all patients (9% vs 45.4%, p < 0.05) and lower esophageal sphincter pressure, measured in 13 patients, increased (19.0+/-3.7 vs 15.7+/-5.3 mm Hg, p < 0.05).
Adult celiac patients with steatorrhea present a higher prevalence of esophageal symptoms and a lowered lower esophageal sphincter pressure compared with celiac patients without steatorrhea and control subjects, but these phenomena can be reverted to control levels by gluten-free diet.
已有报道称乳糜泻患儿反流性食管炎的患病率较高，成年患者存在肠道运动障碍。本研究的目的是调查成年乳糜泻患者在无麸质饮食前后食管症状的患病率及食管动力模式。
对22例连续的成年乳糜泻患者在无麸质饮食前后，以及对对照组，我们计算了关于烧心、反流、吞咽困难和胸痛的食管症状评分，并使用持续灌注的多腔导管进行食管测压。
患者分为两组：有脂肪泻和无脂肪泻。在无麸质饮食前，所有患者食管症状的患病率为45.5%，但有脂肪泻的患者明显高于无脂肪泻的患者及44名对照受试者（80%对16.7%和27%，p<0.05）。所有患者的食管下括约肌压力为17.5±5.3，但有脂肪泻的患者明显低于无脂肪泻的患者及11名对照受试者（13.1±4.1对21.0±2.9和20.7±3.7 mmHg（平均值±标准差，p<0.05）。饮食后，所有患者食管症状的患病率降低（9%对45.4%，p<0.05），对13例患者测量的食管下括约肌压力升高（19.0±3.7对15.7±5.3 mmHg，p<0.05）。
与无脂肪泻的乳糜泻患者及对照受试者相比，有脂肪泻的成年乳糜泻患者食管症状的患病率更高，食管下括约肌压力更低，但这些现象可通过无麸质饮食恢复到对照水平。
