Nielsen I J, Bremner C G
S Afr Med J. 1976 Oct 12;50(45):1822-5.
Previous reports on the profile of lower oesophageal sphincter (LOS) pressures and swallow responses in achalasia have been conflicting. Both normal and high resting pressures have been reported. Many reports have noted a failure of relaxation of the LOS in response to swallowing. Manometric studies were performed on 17 untreated patients with achalasia, of whom 76% were found to have a resting peak end-inspiratory pressure significantly greater than normal (P = 0,001). Nine patients showed relaxation of the LOS in response to swallowing but this relaxation was usually inadequate and of brief duration. Contractions were premature in 16 patients. One patient showed a manometric pattern closely simulating a Mobitz type 1 atrioventricular block in response to repeated swallows. A common pathophysiological process is postulated. In one patient an injection of secretin reduced the high resting LOS pressure. This supports previous evidence that a hypersensitive sphincter in achalasia is due to a hypersensitivity to gastrin. Hyoscine-N-butylbromide (Buscopan) caused a significant reduction in LOS pressure in all patients in whom it was used.
先前关于贲门失弛缓症患者下食管括约肌（LOS）压力及吞咽反应特征的报告相互矛盾。有报告称静息压力正常，也有报告称静息压力高。许多报告指出，吞咽时LOS无法松弛。对17例未经治疗的贲门失弛缓症患者进行了测压研究，其中76%的患者静息吸气末峰值压力显著高于正常（P = 0.001）。9例患者吞咽时LOS出现松弛，但这种松弛通常不充分且持续时间短暂。16例患者出现收缩过早。1例患者在反复吞咽时，测压模式酷似莫氏I型房室传导阻滞。推测存在一个共同的病理生理过程。1例患者注射促胰液素后，高静息LOS压力降低。这支持了先前的证据，即贲门失弛缓症中括约肌过敏是由于对胃泌素过敏。山莨菪碱-N-丁溴化物（解痉灵）在所有使用它的患者中均使LOS压力显著降低。
