Clouse R E, Alrakawi A, Staiano A
Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri, USA.
Dig Dis Sci. 1998 Sep;43(9):1978-85. doi: 10.1023/a:1018838710214.
Topographic plots linking averaged manometric data in time and space suggest that sequential contraction segments form esophageal peristalsis. A system capable of plotting individual swallows was developed to verify this observation and to determine intersubject and interswallow variability in their topographic appearance. Fourteen volunteers were studied with a novel computerized assimilation method capable of generating topographic contour plots as well as conventional wave forms for analysis. Contraction segments in the proximal body and lower sphincter were identified in all subjects as being separate from the remainder of the esophagus with little interswallow variation. The appearance of peristalsis through the distal body was more variable because of its intermittent separation into two dominant contraction segments (59.8% of swallows) that had poorly correlated contraction strength (median r = 0.15). Intersubject variability exceeded interswallow variability in topographic landmarks, resulting in distinctive topographic "fingerprints" of peristalsis for each subject. We conclude that topographic plotting of single swallows is feasible and confirms the presence of sequential contraction segments in the esophagus. Interswallow variability helps demonstrate two segments within the smooth-muscle body, an anatomical region of seeming homogeneity, that have sufficient contraction independence to indicate separate neuromuscular units responding to different contractile influences.
将平均测压数据在时间和空间上进行关联的地形图显示，连续的收缩段形成了食管蠕动。开发了一种能够绘制个体吞咽情况的系统，以验证这一观察结果，并确定其地形图外观在个体间和吞咽间的变异性。对14名志愿者采用一种新型计算机同化方法进行研究，该方法能够生成地形图等高线图以及用于分析的传统波形图。在所有受试者中，近端食管体部和下括约肌的收缩段与食管其余部分明显分开，吞咽间变化很小。食管远端体部的蠕动表现变化更大，因为它会间歇性地分离为两个主要收缩段（59.8%的吞咽情况），这两个收缩段的收缩强度相关性很差（中位数r = 0.15）。在地形图标志方面，个体间变异性超过了吞咽间变异性，导致每个受试者的蠕动具有独特的地形图“指纹”。我们得出结论，单吞咽的地形图绘制是可行的，并证实了食管中存在连续收缩段。吞咽间变异性有助于证明在看似均匀的平滑肌体部内存在两个段，这两个段具有足够的收缩独立性，表明有不同的神经肌肉单位对不同的收缩影响作出反应。
