Malhi-Chowla N, Achem S R, Stark M E, DeVault K R
Division of Gastroenterology and Hepatology, Mayo Clinic Jacksonville, Florida, USA.
Am J Gastroenterol. 2000 Jun;95(6):1417-21. doi: 10.1111/j.1572-0241.2000.02072.x.
We sought to determine whether routinely performing upper esophageal sphincter/pharyngeal (UES/P) manometry in patients referred for esophageal testing alters clinical practice.
Clinical history along with radiography and manometry studies were reviewed in 470 patients referred for manometry. A total of 435 (92.6%) were found to have adequate evaluation of the UES/P and were included in the study.
Of 435 studies, 80 (17.7%) had one or more UES/P abnormalities. Indications for these 80 studies were dysphagia in 30 cases (37.5%), chest pain in 26 (32.5%), both in four (5.0%), and other in 20 (25%). There were 85 manometric abnormalities in the 80 studies: hypertensive UES in 16 cases (18.8%), incomplete UES relaxation in 38 (44.7%), hypertensive pharynx in seven (8.2%), hypotensive pharynx in 15 (17.6%), and abnormal coordination in nine (10.6%). A total of 41 patients had a barium study, which was normal in 11 cases (26%), confirmed the problem in 16 (40%), and suggested another problem in 14 (34%). In 17 patients (21%), there was clinical suspicion for an oropharyngeal disorder before manometry, whereas in 58 cases it was an unexpected finding. Of the 58 patients with an unexpected finding, therapy based on this finding was offered in six (three esophageal dilations, two dietary changes, and one swallowing therapy). If patients with concomitant esophageal body disorders are excluded, in only three patients an unexpected UES finding led to change in management.
An unexpected UES/P finding resulted in a change in therapy in only six of the manometries. Barium esophagogram was diagnostic of the oropharyngeal abnormality in nearly two-thirds of the patients in whom it was clinically suspected. These data, along with limited therapeutic options, suggest limited usefulness for routine UES/P manometry.
我们试图确定在因食管检查而转诊的患者中常规进行上食管括约肌/咽部（UES/P）测压是否会改变临床实践。
回顾了470例因测压而转诊患者的临床病史、影像学检查和测压研究。总共435例（92.6%）患者对上食管括约肌/咽部进行了充分评估，并纳入研究。
在435项研究中，80项（17.7%）存在一项或多项上食管括约肌/咽部异常。这80项研究的指征包括吞咽困难30例（37.5%）、胸痛26例（32.5%）、两者皆有4例（5.0%）、其他20例（25%）。这80项研究中有85项测压异常：UES高压16例（18.8%）、UES不完全松弛38例（44.7%）、咽部高压7例（8.2%）、咽部低压15例（17.6%）、协调性异常9例（10.6%）。共有41例患者进行了钡餐检查，其中11例（26%）正常，16例（40%）证实了问题，14例（34%）提示存在其他问题。17例患者（21%）在测压前临床怀疑存在口咽疾病，而58例为意外发现。在58例意外发现的患者中，基于该发现进行治疗的有6例（3次食管扩张、2次饮食调整和1次吞咽治疗）。如果排除合并食管体部疾病的患者，只有3例意外的UES发现导致了治疗方案的改变。
在仅6例测压中，意外的UES/P发现导致了治疗方案的改变。在近三分之二临床怀疑存在口咽异常的患者中，食管钡餐造影可诊断该异常。这些数据以及有限的治疗选择表明，常规UES/P测压的实用性有限。
