Hong S N, Rhee P-L, Kim J H, Lee J H, Kim Y-H, Kim J J, Rhee J C
Division of Gastroenterology, Department of Medicine, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Dig Liver Dis. 2005 Jul;37(7):475-84. doi: 10.1016/j.dld.2005.01.018. Epub 2005 Apr 18.
The diagnostic values of particular symptoms centred on oesophagus, among patients with suspected oesophageal motility abnormality or pathological acid exposure, are not yet fully understood. The aim of this study was to determine the predictive accuracy of these symptoms in diagnosis of oesophageal motility disorder or pathological acid exposure. PATIENTS AND METHODS.: A total of 462 patients who had undergone conventional oesophageal manometry and ambulatory 24-h pH monitoring to investigate a clinical suspicion of oesophageal motility disorder and pathological acid exposure were enrolled in this study. According to their principal complaints, the patients were divided into the dysphagia category, the non-cardiac chest pain category, the gastrooesophageal reflux disease-related symptom category and the extraoesophageal symptom category.
Two hundred and two (44%) out of 462 patients yielded abnormal findings on manometry and/or pH monitoring. Dysphagia was associated with a likelihood ratio (LR) of 2.11 [95% confidence interval (CI), 1.02-4.00)] in patients exhibiting a combination of oesophageal motility abnormality and pathological acid exposure. During oesophageal manometry, the dysphagia substantially increased the likelihood of classic achalasia (LR, 6.24; 95% CI, 3.32-8.78) and diffuse oesophageal spasm (LR, 3.58; 95% CI, 1.03-7.12). When the patients with dysphagia were divided into two groups according to the severity of their symptoms, classic achalasia was significantly frequent in patients with severe dysphagia (P = 0.016). On the other hand, non-cardiac chest pain was the clinical factor that reduced the likelihood of classic achalasia (LR, 0.22; 95% CI, 0.04-0.93). The distribution of pathological acid exposure was significantly frequent between the groups of patients with and without gastrooesophageal reflux disease-related symptom (P = 0.011).
A small number of oesophageal symptoms are helpful in predicting the likelihood of abnormal findings on oesophageal tests among patients with a clinical suspicion of oesophageal motility disorder and pathological acid exposure. The most useful finding is a severe dysphagia, which is likely to have classic achalasia.
在疑似食管动力异常或病理性酸暴露的患者中，以食管为中心的特定症状的诊断价值尚未完全明确。本研究的目的是确定这些症状在诊断食管动力障碍或病理性酸暴露方面的预测准确性。
本研究共纳入462例因临床怀疑食管动力障碍和病理性酸暴露而接受常规食管测压和24小时动态pH监测的患者。根据主要症状，将患者分为吞咽困难组、非心源性胸痛组、胃食管反流病相关症状组和食管外症状组。
462例患者中有202例（44%）在测压和/或pH监测中发现异常。在同时存在食管动力异常和病理性酸暴露的患者中，吞咽困难的似然比（LR）为2.11[95%置信区间（CI），1.02 - 4.00]。在食管测压过程中，吞咽困难显著增加了典型贲门失弛缓症的可能性（LR，6.24；95%CI，3.32 - 8.78）和弥漫性食管痉挛的可能性（LR，3.58；95%CI，1.03 - 7.12）。当根据症状严重程度将吞咽困难患者分为两组时，严重吞咽困难患者中典型贲门失弛缓症的发生率显著更高（P = 0.016）。另一方面，非心源性胸痛是降低典型贲门失弛缓症可能性的临床因素（LR，0.22；95%CI，0.04 - 0.93）。病理性酸暴露的分布在有和没有胃食管反流病相关症状的患者组之间显著不同（P = 0.011）。
少数食管症状有助于预测临床怀疑食管动力障碍和病理性酸暴露患者食管检查异常结果的可能性。最有用的发现是严重吞咽困难，这可能提示典型贲门失弛缓症。
