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目的研究非糜烂性反流病(NERD)患者对食管气囊扩张的机械性刺激和食管滴酸化学性刺激的感觉反应,以明确内脏高敏感在 NERD 中的作用。方法 10例健康对照者、31例经反流性疾病诊断问卷(RDQ)和内镜诊断为 NERD 的患者参与试验。采用 Synectics 内脏刺激器/电子气压泵行食管气囊扩张,测定其机械性感觉阈值,以气囊充气容积表示;行食管酸灌注试验测定其化学性感觉阈值,以触发症状时间和酸相关症状积分表示。结果 NERD 患者食管对气囊扩张刺激的初始感知阈值、疼痛阈值分别为(9.6±4.8)ml 和(12.3±3.2)mI,对照组为(1 3.2±7.5)ml 和(21.6±5.7)ml(P<0.01),70.9%的 NERD 患者酸灌注试验阳性(P<0.01),平均症状诱发时间为(4.8±2.1)min,对酸和(或)机械性刺激过敏的 NERD 患者总计占74.2%;对照组仅1例酸灌注试验阳性。结论 NERD 患者对食管机械扩张刺激、酸刺激的感觉阈值均降低,内脏高敏感性在 NERD 的发生机制中起重要作用。
Objective To investigate the mechanical response to esophageal balloon dilatation and the sensory response of esophageal drip acid chemical stimulation in patients with non-erosive reflux disease (NERD) to clarify the role of visceral hypersensitivity in NERD. Methods Ten healthy controls and 31 patients with reflux disease diagnosis (RDQ) and endoscopic diagnosis of NERD were enrolled in the trial. Using the Synectics visceral stimulator / electronic pneumatic pump to expand the esophageal balloon, the mechanical sensory threshold was measured and expressed as the inflated balloon volume. The sensory threshold of esophageal acid perfusion was measured by esophageal acid perfusion test, and the symptom time and acid-related symptom scores were indicated. Results The initial sensory threshold and the pain threshold were (9.6 ± 4.8) ml and (12.3 ± 3.2) mI in esophageal dilatation of NERD patients and (21.2 ± 7.5) ml and (21.6 ± 5.7) ml in control group <0.01). The acid perfusion test was positive in 70.9% of NERD patients (P <0.01), the mean symptom onset time was (4.8 ± 2.1) min, and 74.2% of patients with NERD were allergic to acid and / or mechanical stimulation. Only 1 case of acid perfusion test was positive. Conclusion NERD patients with esophageal mechanical dilatation and stimulation, sensory threshold of acid stimulation decreased, visceral hypersensitivity plays an important role in the pathogenesis of NERD.