支气管哮喘在胃食管反流病中的作用研究
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摘要
目的分析支气管哮喘合并胃食管反流病(gastroesophageal reflux disease,GERD)患者的高分辨率食管测压(high resolution manometry,HRM)、食管24hpH监测特点,探讨支气管哮喘在胃食管反流病中对食管酸暴露及食管动力的作用。方法收集2013年1月-2017年6月于新疆维吾尔自治区人民医院普外微创研究所行HRM、食管24hpH监测的82例患者的临床资料。其中,GERD合并哮喘患者(GERD合并哮喘组)22例,GERD非哮喘患者(GERD非哮喘组)39例,排除GERD及哮喘的阴性患者21例(阴性组),分析3组HRM、食管24hpH监测特点。结果食管动力比较中,GERD合并哮喘组食管上括约肌(upper esophageal sphincter,UES)残余压较GERD非哮喘组更低(P<0.05),但3组食管下括约肌(lower esophageal sphincter,LES)长度、LES静息压、LES残余压、UES静息压、UES残余压以及食管远端收缩积分差异均无统计学意义(P>0.05)。食管酸暴露比较中,GERD合并哮喘组患者食管24hpH监测pH≤4(酸反流)的总次数较阴性组多(P<0.05),但与GERD非哮喘组之间差异无统计学意义(P>0.05);GERD合并哮喘组及GERD非哮喘组中,DeMeester评分较阴性组高(P<0.05),但GERD合并哮喘组与GERD非哮喘组之间差异无统计学意义(P>0.05);3组40.05)。结论哮喘并不能加重或减轻GERD患者食管酸暴露水平;对LES长度、功能以及远端食管收缩力等食管动力学指标并无明显影响,但可以明显降低GERD患者UES残余压力。
Objective To investigate the influence of asthma on Gastroesophageal Reflux Disease(GERD)through analyzing the result of High Resolution Manometry(HRM)and 24-hour ambulatory pH monitoring in GERD patients with and without asthma.Methods All selected patients who underwent HRM and24-hour ambulatory pH monitoring were divided into 3 groups,group of GERD combined with Asthma(22 cases),group of GERD without Asthma(39 cases)and group of control(21 cases),based on the presence of GERD or asthma or either of them and retrospectively analyzed their esophageal motility and acid exposure respectively.Results In terms of esophageal motility,GERD patients combined with asthma showed statistically lower result on Mean Upper Esophageal Sphincter(UES)residual pressure compared with GERD patients without asthma(P <0.05)though the Low Esophageal Sphincter(LES)length,LES pressure,basal UES pressure and Distal Contractile Integral(DCI)had no significant difference between these two groups(P >0.05).The asthmatics with GERD presented more acid reflux events(pH≤4)than the negative group with no GERD or asthma.However when compared with GERD group without asthma,GERD with asthma showed no difference neither on the weak acidic reflux events(40.05).Conclusion These findings suggest that asthma doesn′t aggravate the esophageal acid exposure of GERD patients but plays an important role in the proximal esophageal motility by significantly decreasing the UES residual pressure.
Objective To investigate the influence of asthma on Gastroesophageal Reflux Disease(GERD)through analyzing the result of High Resolution Manometry(HRM)and 24-hour ambulatory pH monitoring in GERD patients with and without asthma.Methods All selected patients who underwent HRM and24-hour ambulatory pH monitoring were divided into 3 groups,group of GERD combined with Asthma(22 cases),group of GERD without Asthma(39 cases)and group of control(21 cases),based on the presence of GERD or asthma or either of them and retrospectively analyzed their esophageal motility and acid exposure respectively.Results In terms of esophageal motility,GERD patients combined with asthma showed statistically lower result on Mean Upper Esophageal Sphincter(UES)residual pressure compared with GERD patients without asthma(P <0.05)though the Low Esophageal Sphincter(LES)length,LES pressure,basal UES pressure and Distal Contractile Integral(DCI)had no significant difference between these two groups(P >0.05).The asthmatics with GERD presented more acid reflux events(pH≤4)than the negative group with no GERD or asthma.However when compared with GERD group without asthma,GERD with asthma showed no difference neither on the weak acidic reflux events(4
引文
[1]刘东华.埃索美拉唑治疗支气管哮喘合并胃食管反流疗效观察[J].现代中西医结合杂志,2015(32):3602-3604.
[2]HOUGHTON L A,LEE A S,BADRI H,et al.Respiratory disease and the oesophagus:reflux,reflexes and microaspiration[J].Nat Rev Gastroenterol Hepatol,2016,13(8):445-460.
[3]AMARASIRI W A,PATHMESWARAN A,DE SILVA A P,et al.Gastric motility following ingestion of a solid meal in a cohort of adult asthmatics[J].J Neurogastroenterol Motil,2013,19(3):355-365.
[4]TARIQ K,BARBER C,GOVE K,et al.Role of gastro-oesophageal reflux in severe asthma:experience from the wessex severe asthma cohort[J].Eur Respir J,2015,46(suppl59):PA4578.
[5]刘映霞,江山平,谭艳芳.抗反流药物治疗对支气管哮喘伴胃食管反流患者哮喘症状影响的荟萃分析[J].中华结核和呼吸杂志,2010,33(11):823-830.
[6]GAUDE G S,HATTIHOLI J,BHOMA G,et al.Prevalence of GERD in bronchial asthma and COPD:assessment using FSSG scale and gastroesophageal endoscopy[J].J Evol Med Dent Sci,2014,3(22):6087-6095.
[7]HONG C M,GALVAGNO S M J R.Patients with chronic pulmonary disease[J].Med Clin North Am,2013,97(6):1095-1107.
[8]BABAEI A,DUA K,NAINI S R,et al.Response of the upper esophageal sphincter to esophageal distension is affected by posture,velocity,volume,and composition of the infusate[J].Gastroenterology,2012,142(4):734-743.
[9]COCK C,JONES C A,HAMMER M J,et al.Modulation of upper esophageal sphincter(UES)relaxation and opening during volume swallowing[J].Dysphagia,2017,32(2):216-224.
[10]KWIATEK M A,PANDOLFINO J E,HIRANO I,et al.Esophagogastric junction distensibility assessed with an endoscopic functional luminal imaging probe(EndoFLIP)[J].Gastrointest Endosc,2010,72(2):272-278.
[11]ZERBIB F,GUISSET O,LAMOULIATTE H,et al.Effects of bronchial obstruction on lower esophageal sphincter motility and gastroesophageal reflux in patients with asthma[J].Am J Respir Crit Care Med,2002,166(9):1206-1211.
[2]HOUGHTON L A,LEE A S,BADRI H,et al.Respiratory disease and the oesophagus:reflux,reflexes and microaspiration[J].Nat Rev Gastroenterol Hepatol,2016,13(8):445-460.
[3]AMARASIRI W A,PATHMESWARAN A,DE SILVA A P,et al.Gastric motility following ingestion of a solid meal in a cohort of adult asthmatics[J].J Neurogastroenterol Motil,2013,19(3):355-365.
[4]TARIQ K,BARBER C,GOVE K,et al.Role of gastro-oesophageal reflux in severe asthma:experience from the wessex severe asthma cohort[J].Eur Respir J,2015,46(suppl59):PA4578.
[5]刘映霞,江山平,谭艳芳.抗反流药物治疗对支气管哮喘伴胃食管反流患者哮喘症状影响的荟萃分析[J].中华结核和呼吸杂志,2010,33(11):823-830.
[6]GAUDE G S,HATTIHOLI J,BHOMA G,et al.Prevalence of GERD in bronchial asthma and COPD:assessment using FSSG scale and gastroesophageal endoscopy[J].J Evol Med Dent Sci,2014,3(22):6087-6095.
[7]HONG C M,GALVAGNO S M J R.Patients with chronic pulmonary disease[J].Med Clin North Am,2013,97(6):1095-1107.
[8]BABAEI A,DUA K,NAINI S R,et al.Response of the upper esophageal sphincter to esophageal distension is affected by posture,velocity,volume,and composition of the infusate[J].Gastroenterology,2012,142(4):734-743.
[9]COCK C,JONES C A,HAMMER M J,et al.Modulation of upper esophageal sphincter(UES)relaxation and opening during volume swallowing[J].Dysphagia,2017,32(2):216-224.
[10]KWIATEK M A,PANDOLFINO J E,HIRANO I,et al.Esophagogastric junction distensibility assessed with an endoscopic functional luminal imaging probe(EndoFLIP)[J].Gastrointest Endosc,2010,72(2):272-278.
[11]ZERBIB F,GUISSET O,LAMOULIATTE H,et al.Effects of bronchial obstruction on lower esophageal sphincter motility and gastroesophageal reflux in patients with asthma[J].Am J Respir Crit Care Med,2002,166(9):1206-1211.