摘要
目的应用食管高分辨率测压(high-resolution esophageal manometry,HRM)联合24 h食管多通道腔内阻抗-p H监测(multichannel intraluminal esophageal impedance and p H monitoring,MII-p H)探讨胃食管反流性咳嗽(gastroesophageal reflux cough,GERC)的食管动力和胃食管反流特点。方法收集2014年1月-2014年7月在华中科技大学同济医学院附属同济医院就诊的28例GERC患者,应用HRM测定上食管括约肌(UES)和下食管括约肌(LES)压力、食管体部蠕动功能,同时联合MII-p H观察立位、卧位及餐后酸反流、弱酸反流和非酸反流的次数、食管近端反流的次数和反流类型包括液体反流、混合反流和气体反流及De Meester评分等。以同期仅表现为典型烧心、反酸等胃食管反流症状的胃食管反流病(gastroesophageal reflux disease,GERD)患者作为对照,比较两组食管运动功能及阻抗-p H监测参数之间的差异。结果与典型GERD患者相比,GERC患者的UES静息压力明显降低(P<0.01);食管体部近端收缩波幅降低(P<0.05);而LES静息压力、食管体部远端收缩波幅和食管体部异常蠕动比例差异无统计学意义(P>0.05)。MII-p H结果显示,GERC患者总反流次数和食管近端反流比与典型GERD患者相比,差异无统计学意义(P>0.05),但立位反流次数明显高于典型GERD患者(P<0.05);两组之间反流类型液体反流和混合反流次数差异无统计学意义(P>0.05),但GERC组气体反流次数显著高于典型GERD组(P<0.01);两组之间De Meester评分差异无统计学意义(P>0.05)。结论 GERC的反流发生机制可能与典型GERD不同,与UES静息压力降低、食管体部近端清除能力下降、食管反流次数尤其气体反流次数和立位反流次数增加有关。
Objective To investigate the characteristics of gastroesophageal reflux cough（ GERC） with high-resolution esophageal manometry（ HRM） and multichannel intraluminal esophageal impedance and p H monitoring（ MII-p H）.Methods Twenty-eight patients with GERC and 19 patients with typical gastroesophageal reflux disease（ GERD） were collected from Jan. 2014 to Jul. 2014. HRM and MII-p H were underwent to detect the pressure of upper and lower esophageal sphincter（ UES and LES）,esophageal body peristalsis,the number of acid reflux,weakly acid reflux and non-acid reflux in vertical,supine position,postprandial and proximal esophagus. The type of reflux including liquid,gas and mixed reflux and De Meester score were also observed between two groups. Results Compared with typical GERD group,the UES and proximal esophagus contraction amplitude were obviously lower in GERC group（ P〈0. 01,P〈0. 05）; but there were no significant differences in LES,distant esophagus contraction amplitude and the percent of abnormal esophageal body peristalsis between two groups（ P〈0. 05）. MII-p H demonstrated that compared with typical GERD group,there were no differences in the total refluxes and proximal esophagus refluxes,however,the refluxes in vertical position was obviously higher in GERC group（ P〈0. 05）. Furthermore,there were no significant differences in liquid and mixed refluxes,but gas reflux in GERC group was obviously higher than that in typical GERD group（ P〈0. 01）. There was no difference in De Meester score between two groups（ P〉0. 05）. Conclusion The physiopathologic mechanisms between GERC and typical GERD might be different,it may relate to lower UES,the decrease of proximal esophageal body clearance ability and the increase of refluxes especially gas refluxes and vertical position refluxes.
出处
《胃肠病学和肝病学杂志》
CAS
2015年第10期1196-1199,共4页
Chinese Journal of Gastroenterology and Hepatology
关键词
胃食管反流性咳嗽
食管高分辨率测压
阻抗-pH监测
Gastroesophageal reflux cough
High-resolution esophageal manometry
Esophageal impedance and pH monitoring
