胃食管反流病患者胃食管连接部屏障功能的探讨

目的 探讨胃食管连接部（EGJ）屏障功能在胃食管反流病（GERD）发病机制中的作用。方法 96例具有典型胃食管反流症状的患者接受胃镜检查。42例反流性食管炎（RE）患者按照LA标准分为A～D级,其中LA分型A、B组31例,C、D组11例;54例NERD患者接受24h食管pH监测,根据DeMeester评分分为pH阴性组和pH阳性组,其中pH阴性组31例,pH阳性组23例。健康对照组18例。所有受试者接受食管压力测定,观察指标包括EGJ功能及食管体部收缩压。EGJ功能指标包括静息时的下食管括约肌压（LESP）、平静呼吸时的膈脚压（CDP）、EGJ压（EGJP）及下食管括约肌松弛后压（post—LESRP）。结果 RE组LESP、CDP、EGJP、post—LESRP均低于NERD组（均P〈0.05）;NERD组LESP[（94-3）mmHg,1mmHg=0．133kPa]及post—LESRP[（394-15）mmHg]均低于健康对照组[（164-4）mmHg,（504-15）mmHg,均P〈0．05],但CDP[（184-6）mmHg]及EGJP[（284-8）mmHg]与健康对照组比较,差异均无统计学意义[（164-6）mmHg,（324-7）mmHg,均P〉0．05];NERD组及RE组食管体部远端收缩压均低于健康对照组,但二组间差异无统计学意义（均P〉0．05）。LA—C、D组食管动力功能指标与LA—A、B组差异无统计学意义,24h食管pH监测阴性组与pH监测阳性组NERD患者食管动力功能指标也差异也无统计学意义（均P〉0.05）。结论 GERD患者的EGJ抗反流功能削弱,其中NERD患者膈脚功能较RE患者健全,是NERD有别于RE的重要机制。

Barrier function of esophagogastric junction in patients with gastroesophageal reflux disease

OBJECTIVE: To investigate the barrier function of esophagogastric junction (EGJ) in the patients with gastroesophageal reflux diseases (GERD). METHODS: Ninety-six GERD patients and 18 healthy subjects (HSs) underwent esophageal manometry. Forty-two of the 96 patients were with reflux esophagitis (RE) and were divided into 2 subgroups according to the LA typing: 31 subgroup of LA-A or B (n = 31), and subgroup of LA-C or D (n = 11). Fifty-four of the 96 patients suffered from non-erosive reflux disease (NERD) and were divided into 2 subgroups based on 24 h esophageal pH monitoring: 31 patients with normal acid exposure (pH < 14.72 according to DeMeester scoring) and 23 with excessive acid exposure (pH > 14.72). The EGJ functions, including lower esophageal sphincter pressure (LESP), crura of diaphragm pressure (CDP), esophagogastric junction pressure (EGJP, sum of LESP and CDP), and post-lower esophageal sphincter relaxation pressure (post-LESRP), and the contractive pressure of esophageal body, including proximal esophageal contractive pressure (PECP) and distal esophageal contractive pressure (DECP), were measured. RESULTS: The levels of LESP, CDP, EGJP, and post-LESRP of the RE patients were (8 +/- 3), (13 +/- 7), (20 +/- 9), and (31 +/- 13) mm Hg respectively, all significantly lower than those of the NERD patients [(9 +/- 3), (18 +/- 6), (28 +/- 8), and (39 +/- 15) mm Hg, all P < 0.05]. The levels of LESP and post-LESRP of the NERD patients were significantly lower than those of the HSs [(32 +/- 7) and (50 +/- 15) mm Hg, both P < 0.05], however, the levels of CDP and EGJP of the NERD patients were both not significantly different from those of the HSs [(16 +/- 6) and (32 +/- 7) mm Hg, both P > 0.05]. The PECP and DECP of the RE and NERD patients were all significantly lower than those of the HSs (all P < 0.05), however, there were not significant differences in DECP and PECP between the RE and NERD patients (both P > 0.05). Among the NERD patients there were not significant differences in the PECP and DECP between the LA-A and B subgroup and RE LA-C and D subgroup, and among the NERD patients there were not significant differences in PECP and DECP between the subgroups with and without excessive esophageal acid exposure (all P > 0.05). CONCLUSION: The EGF anti-reflux function of the GERD patients is impaired. The function of crura of diaphragm of the NERD patients is almost normal, however, that of the RE patients is impaired. NERD and RE have different path physiological basis.