rentradВестник рентгенологии и радиологииJournal of radiology and nuclear medicine0042-46762619-0478Limited Liability Company "LUCHEVAYA DIAGNOSTIKA", Russian Association of Radiologists10.20862/0042-4676-2015-0-1-5-15rentrad-1Research ArticleСтатьиКольцо Шацкого как симптом гастроэзофагеальной рефлюксной болезниSchatzki ring as a symptom of gastroesophageal reflux diseaseЛевинМ. Д.LevinM. D.

д. м. н., рентгенолог

MD, PhD, DSc, Radiologist

МендельсонГ.Mendel'sonG.

главный врач

Head Physician

Государственный гериатрический центрИзраильState Geriatric CenterIsrael20152702201601515Copyright © Левин М.Д., Мендельсон Г., 20162016Левин М.Д., Мендельсон Г.Levin M.D., Mendel'son G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.russianradiology.ru/jour/article/view/1

Цель исследования – определить значимость симптома кольца Шацкого.

Материал и методы

Материал и методы. Представлен анализ результатов обследования 95 больных в возрасте 62–92 лет с симптомами диспепсии, проведенного в Государственном гериатрическом центре г. Нетания (Израиль) в 1994–2004 гг. Стандартное рентгенологическое исследование верхних отделов пищеварительного тракта дополнялось провокационными тестами. Измеряли длину рентгенонегативной зоны (РНЗ) между барием в пищеводе и в желудке, а также ширину в нижней части пищевода.

Результаты

Результаты. Только у 2 (2%) из 95 больных обнаружена нормальная функция пищеводно-желудочного перехода (ПЖП). Двое больных с резким сужением пищевода вследствие рефлюкс-эзофагита исключены из исследования. Оставшиеся (91) больные разделены на две группы. У 64 (70%) из них ширина пищевода была меньше 2 см, а у 27 (30%) – 2 см и более. При слабости ПЖП над РНЗ появляется расширение пищевода. В горизонтальном положении из этой части пищевода содержимое эвакуируется в желудок в результате функционирования ампулы пищевода. Она замыкается проксимально в результате сокращения функционального проксимального сфинктера (ПС). При сокращении ампулы давление в ней увеличивается до порогового уровня. Это приводит к раскрытию РНЗ, и ампула впрыскивает свое содержимое в желудок. Чем шире была ампула, тем короче была РНЗ. У 20 (22%) больных с гастроэзофагеальной рефлюксной болезнью (ГЭРБ) обнаружено кольцо Шацкого. Оно всегда находилось на уровне ПС.

Заключение

Заключение. Так называемая скользящая эзофагеальная грыжа представляет собой ампулу пищевода шириной более 2 см. Наличие ампулы пищевода, независимо от ее величины, свидетельствует о несостоятельности ПЖП и наличии ГЭРБ. Кольцо Шацкого возникает на уровне ПС в результате рефлюкс-эзофагита.

 

 

Objective

Objective: to determine the importance of a symptom of Schatzki ring.

Material and methods

Material and methods. The results of examining 95 patients aged 62–92 years with the symptoms of dyspepsia in the Netanya State Geriatric Center (Israel) in 1994–2004 were analyzed. Standard X-ray study of the upper digestive tract was complemented by provocation tests. The length of an X-ray-negative area (XNA) between barium in the esophagus and stomach and the width in the lower esophagus were measured.

Results

Results. Only 2 (2%) of the 95 patients were found to have normal function of the gastroesophageal junction (GEJ). Two patients with a drastic esophageal narrowing due to reflux esophagitis were excluded. The remaining (91) atients were divided into 2 groups. The width of the esophagus was less than 2 cm and 2 cm or more in 64 (70%) and 27 (30%) patients, respectively. In weak GEJ, there was esophageal dilatation above the XNA. When in a horizontal position, this portion of the esophagus evacuates its contents into the tomach as a result of ampullary function. It is proximally closed by ontracting the functional proximal sphincter (PS). When the ampulla contracts, its pressure increases up to the threshold. This causes the XNA to be closed and the ampulla to inject its contents into the stomach. The wider was the ampulla, the shorter the XNA was. Schatzki ring was detected in 20 (22%) of the 91  patients with gastroesophageal reflux disease (GERD). It was always at the level of the PS.

Conclusion

Conclusion. The so-called sliding esophageal hernia is an esophageal  mpulla measuring more than 2 cm in wide. The presence of the esophageal ampulla despite its size suggests that the GEJ is incompetent and GERD is present. Schatzki ring occurs at the level of the PS due to reflux esophagitis.

 

 

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The authors declare that there are no conflicts of interest present.