Bravo胶囊诱发食管高收缩性和胸痛。

Bravo capsule induction of esophageal hypercontractility and chest pain.

作者信息

Tharavej C, Hagen J A, Portale G, Hsieh C-C, Gandamihardja T A K, Lipham J C, Peters J H, DeMeester S R, Crookes P F, Bremner C G, DeMeester T R

机构信息

Division of Thoracic and Foregut Surgery, Department of Surgery, University of Southern California, Los Angeles, CA, USA.

出版信息

Surg Endosc. 2006 May;20(5):783-6. doi: 10.1007/s00464-005-0257-8. Epub 2006 Mar 16.

DOI:10.1007/s00464-005-0257-8

PMID:16544080

Abstract

BACKGROUND

The Bravo catheter-free pH monitoring system uses a capsule attached to the esophageal mucosa to detect acid exposure. Placement of the Bravo capsule is associated with intermittent chest pain in 50% of normal volunteers. The authors hypothesized that chest pain in this setting may be attributable to hypertensive esophageal contractions induced by the Bravo capsule.

METHODS

The study population consisted of 40 consecutive patients with reflux symptoms who had stationary esophageal manometry within 1 h after Bravo capsule placement. The control group consisted of 40 patients with symptomatic gastroesophageal reflux disease (GERD) from a population of patients with foregut symptoms who were computer matched to the study group for age, sex, lower esophageal sphincter (LES) pressure, LES length, and 24-h pH composite score. The patients in the control group had manometry before Bravo capsule placement. The occurrence of chest pain was assessed before and during the monitoring period by interview and review of the patient's diary. Mean contraction amplitudes in the distal third of the esophagus after 10 wet swallows were averaged. The prevalence of patients with esophageal contraction amplitudes in the distal third that exceeded the 95th percentile of normal (180 mmHg) and the mean amplitude of distal third esophageal contractions in the study and control populations were compared. In the study group, the incidence of chest pain among the patients with hypercontractility of the esophagus was compared with the incidence among those without hypercontractility.

RESULTS

The mean contraction amplitude was higher in the study group (144.7 vs 105.5 mmHg; p = 0.002). The number of patients with a mean distal esophageal contraction amplitude exceeding the 95th percentile of normal also was significantly higher in the study group (13/40 vs 5/40; p = 0.03). A total of 10 patients experienced new onset of chest pain with the Bravo capsule in place, and 6 patients experienced hypertensive esophageal contractions.

CONCLUSIONS

The intraesophageal Bravo capsule can cause hypertensive esophageal contractions, which may lead to chest pain.

摘要

背景

Bravo无导管pH监测系统使用附着于食管黏膜的胶囊来检测酸暴露情况。在50%的正常志愿者中，放置Bravo胶囊会伴有间歇性胸痛。作者推测，这种情况下的胸痛可能归因于Bravo胶囊诱发的食管高压性收缩。

方法

研究人群包括40例有反流症状且在放置Bravo胶囊后1小时内进行了静态食管测压的连续患者。对照组由40例有症状的胃食管反流病（GERD）患者组成，这些患者来自有前肠症状的患者群体，通过计算机匹配，使其在年龄、性别、食管下括约肌（LES）压力、LES长度和24小时pH综合评分方面与研究组相同。对照组患者在放置Bravo胶囊前进行了测压。通过访谈和查阅患者日记，评估监测期前后胸痛的发生情况。对10次湿吞咽后食管远端三分之一处的平均收缩幅度进行平均计算。比较研究组和对照组中食管远端三分之一处收缩幅度超过正常第95百分位数（180 mmHg）的患者患病率以及食管远端三分之一处收缩的平均幅度。在研究组中，比较食管收缩亢进患者与无收缩亢进患者的胸痛发生率。