Stein H J, Singh S, Demeester T R
Klinikum rechts der Isar der Technischen Universität Munich, Germany.
Dis Esophagus. 2004;17(4):297-303. doi: 10.1111/j.1442-2050.2004.00429.x.
Esophageal motor abnormalities are currently categorized into separate entities based on standard manometry. The clinical significance of these categories is controversial. We evaluated whether ambulatory 24-h esophageal motility monitoring improves the assessment of patients thought to have a primary esophageal motor disorder. Standard and ambulatory 24-h esophageal motility records of 30 healthy volunteers and 136 symptomatic patients were compared. Regression analysis was used to identify parameters that relate to the presence of nonobstructive dysphagia. Prolonged ambulatory esophageal monitoring showed a marked circadian variation in the esophageal motor pattern and significant discrepancies to the findings on standard manometry in 47% of the 136 patients. Discrepancies were particularly frequent in patients categorized on standard manometry as having a 'nutcracker esophagus' or a nonspecific motor disorder. Of all data obtained, the prevalence of 'effective contractions', i.e. peristaltic contractions with an amplitude > 30 mmHg, during meal periods provided the best correlation with the presence of nonobstructive dysphagia. Of the 78 patients with nonobstructive dysphagia 71 (92%) had less than 50% of 'effective contractions' during meals. In five patients who had frequent simultaneous wave forms and less than 70%'effective contractions' during meals a long myotomy markedly reduced the severity of dysphagia. The 'efficacy' of esophageal contractions during meals best relates to patients' symptoms and allows expression of esophageal body dysfunction on a linear scale. This obviates the need for the current categories of esophageal motor disorders, permits an objective assessment of medical therapy and may improve the identification of patients that benefit from a surgical myotomy of the esophageal body.
目前，食管运动异常是根据标准测压法被分类为不同的实体。这些分类的临床意义存在争议。我们评估了动态24小时食管动力监测是否能改善对被认为患有原发性食管运动障碍患者的评估。比较了30名健康志愿者和136名有症状患者的标准和动态24小时食管动力记录。采用回归分析来确定与非梗阻性吞咽困难存在相关的参数。长时间的动态食管监测显示食管运动模式存在明显的昼夜变化，并且在136名患者中有47%与标准测压结果存在显著差异。差异在标准测压分类为“胡桃夹食管”或非特异性运动障碍的患者中尤为常见。在所有获得的数据中，进餐期间“有效收缩”（即振幅>30 mmHg的蠕动收缩）的发生率与非梗阻性吞咽困难的存在具有最佳相关性。在78名非梗阻性吞咽困难患者中，71名（92%）在进餐期间“有效收缩”少于50%。在5名进餐期间有频繁同步波形且“有效收缩”少于70%的患者中，长肌切开术显著降低了吞咽困难的严重程度。进餐期间食管收缩的“功效”与患者症状最相关，并能以线性尺度表达食管体功能障碍。这消除了对当前食管运动障碍分类的需求，允许对药物治疗进行客观评估，并可能改善对受益于食管体手术肌切开术患者的识别。
