【摘要】 背景:近年来对胃食管反流病(GERD)的食管外症状已有了较深入的了解,但对此类患者的研究多集中于检测反流的存在,而很少正式评估食管动力紊乱在其发病中的作用。目的:研究GERD患者食管动力紊乱对食管外症状发生的影响。方法:39例根据临床表现和内镜检查结果诊断为具有食管炎的GERD患者分为两组,A组:仅有食管症状(n=21);B组:既有食管症状,又有食管外症状(n=18,其中癔球感10例,慢性咳嗽5例,咽痛3例)。采用静态食管测压和24h食管pH监测对两组患者进行研究。结果:B组患者的食管正常蠕动百分比(15.7%±23.3%)和食管不协调蠕动百分比(69.4%±33.6%)分别显著低于和高于A组(55.0%±37.3%和29.8%±32.8%),食管下括约肌(LES)和食管上括约肌(UES)压力均略低于A组,但无显著差异。B组患者的pH<4总时间(218.2min±278.8min)、pH<4反流次数(153.9±181.2)、pH<4总时间百分比(15.6%±20.0%)和立位pH<4时间百分比(17.1%±19.3%)均显著高于A组(83.9min±112.6min、61.2±83.4、5.9%±7.9%和7.1%±9.5%)。结论:食管动力紊乱可使酸反流加重,导致酸直接作用于咽喉部而引起一系列食管外症状。鉴于食管动力紊乱是GERD发病机制中的首要和关键因素,促动力药的应用必不可少。更多还原

【Abstract】 Background:In recent years there has been a deep recognition of the extraesophageal symptoms of gastroesophageal reflux disease(GERD).But most of the studies focus on the detection of reflux,the formal analysis of esophageal dysmotility in the pathogenesis of extraesophageal symptoms is rarely considered.Aims:To investigate the effects of esophageal dys-motility on extraesophageal symptoms in patients with GERD.Methods:Thirty-nine patients with esophagitis and GERD diagnosed by clinical features and endoscopy were divided into two groups:group A having esophageal symptoms only(n=21)and group B having both esophageal and extraesophageal symptoms(n=18),among the latter,10had globus hystericus,5chronic cough and3pharyngalgia.Esophageal manometry and ambulatory24-hour esophageal pH monitoring were used for evaluation.Results:The percentages of normal and incoordinate esophageal peristalsis in patients of group B(15.7%±23.3%and69.4%±33.6%)were significantly lower and higher than those in group A(55.0%±37.3%and29.8%±32.8%),respectively.The pressures of lower esophageal spincter(LES)and upper esophageal sphincter(UES)in group B were lower,but no significant differences were found as compared with those in group A.In group B,the total time of pH<4(218.2min±278.8min),the time of reflux at pH<4(153.9±181.2),the total time percentage of pH<4(15.6%±20.0%)and the up-right time percentage of pH<4(17.1%±19.3%)were all significantly higher than those in group A(83.9min±112.6min,61.2±83.4,5.9%±7.9%and7.1%±9.5%).Conclusions:Esophageal dysmotility can enhance the acid reflux,causing direct acid damage on laryngopharynx,resulting in extraesophageal symptoms.In view of the primary and crucial role of esoph-ageal dysmotility in the pathogenesis of GERD,usage of prokinetic agent is necessary.更多还原