食道アカラシアと軽度食道裂孔ヘルニア

Achalasia and Hiatus Hernia of the Esophagus

　食道胃接合部の機能は大別して2つあり，その1つは接合部開口機序，他の1つは接合部逆流防止機構である．これは接合部の運動機能が全く相反する機能を持っており，正常すなわち生理的には良く合目的的に使い分けられている．しかしながら何かを契機にこれら運動機能が障害されると接合部開口不全，すなわち無弛緩となり，食道アカラシアとなる．また，接合部逆流防止機構不全は食道裂孔ヘルニアに合併して認められる．両者は共に接合部の機能的疾患の性格をもち，したがってその診断も従来のX線，内視鏡検査に加えて食道の機能検査としての食道内圧pH測定が意義を持ってくる．著者は食道アカラシアの診断的事項に加えてその分類とそして食道裂孔ヘルニアについては，食道内圧pH測定の診断的意義について述べる．

食道アカラシア

　Achalasiaなる病名は1914年Hurst¹⁾によって命名されたもので，いわゆる噴門痙攣症²⁾Cardiospasmus，あるいは特発性食道拡張症³⁾Idiopathische Ösophagus Dilatationなどと従来呼ばれてきた疾患である．

　The above-mentioned study relates to the pathophysiology and diagnosis of achalasia which is caused by the disturbance of esophageal motility, the failure of relaxation and closure of the inferior esophageal sphincter. The diagnosis of achalasia can be confirmed by the X-ray examinations, esophagoscopy and manometry, and there is as yet no general agreement but diagnostic criteria about classification of achalasia is becoming firm at present. The present communication introduces the interrelationship among the classifications base on the X-ray findings (by Japanese Society of Esophageal Diseases), esophagoscopic findings and manometric studies (both by our department).

　Also, the present communication relates to hiatus hernia, the clinical complains of which were statistically observed by the enquete and anamnesis for 177 cases of this disease which were experienced in our department for the past ten years since 1965. The present communication additionally relates to the following : hiatus hernia has only received physical diagnosis by the X-ray examinations and esophagoscopy. In our department, however, pathophysiologic and clinical significance have been understood by the usage of physiological examinations such as manometric studies and intraluminal pH measurement. Especially these physiological examinations are very useful for slight hiatus hernia.

　The necessity of manometric studies and intraluminal pH measurement in addition to the X-ray examinations and esophagoscopy is emphasized for the functional disease of esophagus such as achalasia and hiatus hernia.