Korean Journal of Nephrology 1999;18(4):592-598.

지속성 외래 복막투석 환자에서 하부식도 괄약근압과 24시간 식도내 pH 검사 (Lower Esophageal Sphincter Pressure(LESP) and 24-hour(h) Esophageal pH Monitoring in Continuous Ambulatory Peritoneal Dialysis(CAPD) Patients)

권건호, 이승우, 권계숙, 김범수, 김문재 (Kun Ho Kwon, Seoung Woo Lee, Kye Sook Kwon, Pum Soo Kim and Moon Jae Kim)

Abstract

Upper gastrointestinal symptoms such as epigastric fullness, nausea, and vomiting are often observed in CAPD patients. Intraabdominal pressure depends on the amount of dialysate and the body positions. It is not clear whether upper gastrointestinal symptoms are manifestations of raised intraperitoneal pressure produced by dialysate. To investigate the changes of LESP according to the amount of dialysate and the body position and the relationship between LESP and parameters of 24-h esophageal pH monitoring, esophageal manometry and 24-h esophageal pH monitoring were performed in 12 CAPD patients. The sex ratio was 1:2. The duration of CAPD of patients except one was less than 1 month. The mean age was 47.5 15.5(SD) years old. There were no changes in supine LESPs according to the infused volume of dialysate. Sitting LESPs at 500, 1500, and 2000ml were elevated significantly compared to basal sitting LESP(27.1 5.5, 27.0 6.0, and 28.5 7.0 vs. 23.9 5.7mmHg, p<0.05). Supine LESPs at basal and 500ml of dialysate significantly higher than sitting LESPs(30.2 9.1 and 31.2 8.5 vs. 23. 9 5.7 and 27.1 5.5mmHg, p<0.05). There were no differences in LESP by age, sex, and diabetic status. Supine LESP at 2000ml strongly correlated with total reflux episodes(r=-0.92, p<0.01), fraction time of pH<4.0(r=-0.85, p<0.01), and total reflux score(DeMeester)(r=-0.88, p<0.01), but other LESPs did not. When the patients were divided into group I(<30mmHg) and group Ⅱ(330mmHg) by supine LESP at 2000ml, group I had more total reflux episodes(73.7 27.0 vs. 14.0 10.3, p<0.05), fraction time of pH<4.0(4.0 3.7 vs. 0.5 0.4%, p<0.05), and total reflux score(15.2 10.5 vs. 2.8 1.5, p<0.05). In conclusion, CAPD patients seem to have a risk of gastroesophageal reflux due to elevated intraperitoneal pressure by dialysate, especially if supine LESP at 2000ml was lower than 30mmHg.