【摘要】 目的　探讨食管无效收缩 (IEM)在胃食管反流病 (GERD)的发病作用。方法　对GERD病人行食管测压和 2 4h食管pH监测 ,分析IEM在GERD的发生率以及比较IEM与食管酸暴露、酸清除和食管炎的关系。结果　 86例GERD病人中 5 9例 (6 8 6 % )存在非特异性食管动力障碍 (NEMD) ;其中 5 5例 (占 93 2 % )符合IEM诊断标准 ;GERD病的IEM发生率为 6 3 95 %。IEM的GERD患者总的pH <4时间 (% ) (5 91)及立位 (4 4 3)和卧位 (6 92 )pH <4时间 (% )显著大于食管正常蠕动的GERD患者 (分别为 3 16 ,1.6 1,和 4 31) ,尤以卧位明显 (P <0 0 1)。IEM患者平均卧位食管酸清除时间 (EAC)为每次 12 6 3min ,显著长于正常食管动力GERD患者的每次 3 15min(P<0 0 1) ,而立位EAC则与正常食管动力组无差异。 2 7例正常食管动力GERD有 10例 (37% )有糜烂性食管炎 ;5 5例IEM患者有 19例 (35 % )有食管炎 ,二组间食管炎发生比例差异无显著性 (P >0 0 5 )。结论　GERD病的食管动力障碍大多数系IEM。IEM比正常食管动力患者更易发生反流和存在食管酸清除障碍。IEM是GERD病的主要异常表现。更多还原

【Abstract】 Objective To explore the potential role of ineffective esophageal motility(IEM) in the pathogenesis of gastroesophageal reflux disease(GERD).Methods The esophageal manometry and ambulatory pH monitoring findings from patients with GERD were analyzed to identify the prevalence of IEM in patients with GERD.And comparison of esophageal acid exposure,esophageal acid clearance (EAC) and endoscopic esophagitis in GERD patients with IEM were made.Results Of 86 patients with GERD,59 (68.6%) were found to have nonspecific esophageal motility disorder (NEMD);55 of the 59 (93.2%)patients with NEMD met the diagnostic criteria for IEM.The overall incidence of IEM in GERD patients was 63.95%.Patients with IEM demonstrated significant increase in total,upright and recumbent mean percentage of time of pH<4 (5.91,4.43,and 6.92,respectively) and mean recumbent EAC (12.63min/reflux ) compared to those with normal motility(3.16,1.61,4.31 and 3.15min/reflux,respectively),Mean uright EAC in IEM did not differ significantly from that in patients with normal motility. There was no significant difference in the percentage of endoscopic esophagitis between patients with normal motility and with IEM (37% and 35%,respectively).Conclusions The majority of the abnormal esophageal motility was IEM .IEM patients not only had a significantly higher likelihood of abnormal gastroesophageal reflux than those with normal motility,but had more delayed EAC.IEM is a dominating motility disorder in gastroesophgeal reflux disease.更多还原