European journal of gastroenterology & hepatology · 2000
Characteristics of secondary oesophageal peristalsis in operated and non-operated patients with chronic gastro-oesophageal reflux disease.
Клиническое исследованиеСравнительное исследованиеКонтролируемое клиническое исследованиеСтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод пока не подготовлен
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Rydberg L, Ruth M, Lundell L
Аннотация
BACKGROUND AND AIMS: Secondary oesophageal peristalsis contributes to oesophageal volume clearance and may be impaired in a significant proportion of patients with chronic gastro-oesophageal reflux disease (GORD). This study aimed to investigate the triggering of secondary peristalsis in chronic GORD patients compared to those previously operated on with anti-reflux surgery.
PATIENTS AND METHODS: Healthy volunteers, chronic GORD patients with proven oesophagitis and patients successfully operated on with anti-reflux surgery (> 3 years ago) were investigated. Secondary peristalsis was elicited by oesophageal distension by a bolus of air (10 ml) injected rapidly into the mid-portion of the oesophagus. The peristaltic characteristics in the distal oesophagus were assessed by use of stationary manometry.
RESULTS: The primary peristaltic amplitude in the distal third of the oesophagus was significantly higher (P < 0.002) in the non-operated GORD cases than in those recruited for surgery. Furthermore, a difference in the frequency of failed primary peristalsis was revealed (2.1 versus 8.4%) between the non-operated and operated patients. Secondary peristalsis occurred in 65 +/- 13.2% (mean +/- SE) of the healthy subjects on stimulation, which was a higher figure than in the GORD patients. In patients investigated after successful anti-reflux surgery, a secondary peristaltic wave was elicited in only 26 +/- 7.2% of the attempts, which was significantly lower than the 46 +/- 7.7% seen in non-operated GORD patients (P < 0.05). A direct comparison between motor characteristics of primary and secondary peristalsis revealed that the latter amplitudes were significantly lower both in the non-operated and in the operated cases (P < 0.005).
CONCLUSIONS: The triggering of secondary peristalsis seems to be impaired in chronic GORD patients. Investigating similar patients > 3 years after successful anti-reflux surgery revealed an even lower prevalence of secondary peristaltic waves, implying persistence of the abnormality after surgery and consistent with other evidence that GORD is associated with a primary defect in oesophageal motor function.
PATIENTS AND METHODS: Healthy volunteers, chronic GORD patients with proven oesophagitis and patients successfully operated on with anti-reflux surgery (> 3 years ago) were investigated. Secondary peristalsis was elicited by oesophageal distension by a bolus of air (10 ml) injected rapidly into the mid-portion of the oesophagus. The peristaltic characteristics in the distal oesophagus were assessed by use of stationary manometry.
RESULTS: The primary peristaltic amplitude in the distal third of the oesophagus was significantly higher (P < 0.002) in the non-operated GORD cases than in those recruited for surgery. Furthermore, a difference in the frequency of failed primary peristalsis was revealed (2.1 versus 8.4%) between the non-operated and operated patients. Secondary peristalsis occurred in 65 +/- 13.2% (mean +/- SE) of the healthy subjects on stimulation, which was a higher figure than in the GORD patients. In patients investigated after successful anti-reflux surgery, a secondary peristaltic wave was elicited in only 26 +/- 7.2% of the attempts, which was significantly lower than the 46 +/- 7.7% seen in non-operated GORD patients (P < 0.05). A direct comparison between motor characteristics of primary and secondary peristalsis revealed that the latter amplitudes were significantly lower both in the non-operated and in the operated cases (P < 0.005).
CONCLUSIONS: The triggering of secondary peristalsis seems to be impaired in chronic GORD patients. Investigating similar patients > 3 years after successful anti-reflux surgery revealed an even lower prevalence of secondary peristaltic waves, implying persistence of the abnormality after surgery and consistent with other evidence that GORD is associated with a primary defect in oesophageal motor function.