Raptis C A, Levine M S, Rubesin S E, Laufer I, Katzka D A
Departments of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA.
Br J Radiol. 2005 May;78(929):411-5. doi: 10.1259/bjr/24453312.
The purpose of our study was to determine the frequency, radiographic features, and clinical importance of transient failure of opening of the lower oesophageal sphincter (LOS) on upright double-contrast views of the oesophagus. A computerized search of radiology records identified 16 patients who had transient failure of opening of the LOS on upright views from biphasic oesophagrams or upper gastrointestinal tract examinations using high-density barium but normal opening of the LOS on prone views using low-density barium. The radiographic findings were reviewed and correlated with the clinical and manometric findings. In all cases, barium studies revealed tapered, beaklike narrowing of the distal oesophagus on upright double-contrast views, with a normal-appearing distal oesophagus, normal opening of the LOS, and intact peristalsis on prone single-contrast views. Only seven patients (44%) had dysphagia. Five of these patients had clinical follow-up, and the dysphagia improved or resolved without specific treatment for LOS dysfunction in four. The remaining patient had persistent dysphagia, but this individual had polymyositis as the likely cause for his dysphagia. Manometry revealed incomplete relaxation of the LOS in two patients and normal relaxation in one. Our experience suggests that failure of opening of the LOS may be observed as a transient finding of little clinical importance on upright double-contrast views of the oesophagus using high-density barium, with normal opening of the LOS on prone single-contrast views using low-density barium. It is important to be aware of this finding, so that it is not mistaken for achalasia or other abnormalities of the distal oesophagus.
我们研究的目的是确定食管下段括约肌（LOS）在食管立位双重对比造影时一过性开放失败的发生率、影像学特征及临床意义。通过计算机检索放射学记录，我们确定了16例患者，这些患者在使用高密度钡剂进行的双相食管造影或上消化道检查的立位视图中出现LOS一过性开放失败，但在使用低密度钡剂的俯卧位视图中LOS开放正常。我们回顾了影像学表现，并将其与临床和测压结果进行了关联。在所有病例中，钡剂造影显示立位双重对比视图中食管远端呈逐渐变细的鸟嘴样狭窄，而俯卧位单对比视图中食管远端外观正常、LOS开放正常且蠕动完整。只有7例患者（44%）有吞咽困难。其中5例患者进行了临床随访，4例患者在未针对LOS功能障碍进行特殊治疗的情况下吞咽困难得到改善或缓解。其余1例患者吞咽困难持续存在，但该患者患有多发性肌炎，这可能是其吞咽困难的原因。测压显示2例患者LOS松弛不完全，1例患者LOS松弛正常。我们的经验表明，在使用高密度钡剂的食管立位双重对比视图中，LOS开放失败可能表现为一种临床意义不大的一过性发现，而在使用低密度钡剂的俯卧位单对比视图中LOS开放正常。认识到这一发现很重要，以免将其误诊为贲门失弛缓症或食管远端的其他异常。
