Lucendo Alfredo J, Castillo Pilar, Martín-Chávarri Sonia, Carrión Gemma, Pajares Ramón, Pascual Juan M, Manceñido Noemí, Erdozain José C
Department of Gastroenterology, La Paz University Hospital, Autonoma University of Madrid, Madrid, Spain.
Eur J Gastroenterol Hepatol. 2007 May;19(5):417-24. doi: 10.1097/MEG.0b013e328010bd69.
To describe the manometric findings detected in adult patients with dysphagia that were diagnosed of eosinophilic oesophagitis, and to compare with the cases of eosinophilic infiltration of the oesophagus reported in the literature.
We present 12 adult patients diagnosed as suffering from this disorder in our department in a 1.5-year period, according to histological criteria and discarding any other cause of eosinophilic infiltration of the oesophagus. Stationary oesophageal manometry using a hydropneumocapillary perfusion system was performed in every case. The recommendations of the Spanish Group of Digestive Motility were followed for the interpretation of the results. In seven patients who presented motor disorder in manometric evaluation, treatment with steroid oesophageal lavage using fluticasone propionate was carried out and these patients were subsequently re-evaluated.
All patients were young predominantly men, and the first endoscopic examination showed regular concentric stenosis or a 'ring oesophagus'. Six patients had a severe nonspecific oesophageal motor disorder characterized by up to 80% of nontransmitted or very low-amplitude waves in the lower two-thirds of the organ. Three patients presented a manometric disturbance characterized by hyperkinetic peristaltic waves in distal oesophageal third. One patient had an alteration of the oesophageal motor dynamics characterized by 80% of deglutory complexes formed by a primary simultaneous wave in the two lower oesophageal thirds followed by a secondary peristaltic wave in 50% of cases that had a normal duration and amplitude. The remaining two patients had normal oesophageal motility. The upper oesophageal sphincter showed no alterations, and the manometric evaluation of the lower oesophageal sphincter tone proved normal in 10 patients, with slight hypotension in two cases. In seven of the nine patients who presented an oesophageal motor disorder, treatment with steroid oesophageal lavage using fluticasone propionate was administered and a new oesophageal manometry was performed afterwards, in which the motor disorder was clearly improved as soon as dysphagia, endoscopic lesions and histopathologic alteration disappeared.
In the literature, 61 cases of eosinophilic infiltration of the oesophageal mucosa subjected to oesophageal manometric study had been described, and 60.6% of them showed evidence of different types of manometric alterations, mainly with spastic or hypercontractility characteristics. Although six of our cases showed very deficient peristalsis with very low-amplitude or nontransmitted waves, and in another three high-amplitude peristaltic waves were recorded. Motor disorders improved parallel to the disappearance of the eosinophilic infiltration of the mucosa. These data suggest that motor disorders in eosinophilic oesophagitis are a consequence of eosinophil infiltration of the oesophagus and should be considered in the differential diagnosis of dysphagia. These manometric alterations could be considered as primary nonspecific disorders and included in the 'ineffective oesophageal motility' group.
描述诊断为嗜酸性食管炎的成年吞咽困难患者的测压结果，并与文献中报道的食管嗜酸性粒细胞浸润病例进行比较。
我们在1.5年的时间里，在本部门诊治了12例被诊断患有这种疾病的成年患者，依据组织学标准并排除食管嗜酸性粒细胞浸润的任何其他原因。对每例患者均使用液压气毛细管灌注系统进行静态食管测压。结果解读遵循西班牙消化运动学组的建议。对7例在测压评估中出现运动障碍的患者，采用丙酸氟替卡松进行类固醇食管灌洗治疗，随后对这些患者进行重新评估。
所有患者均为年轻人，以男性为主，首次内镜检查显示为规则的同心性狭窄或“环状食管”。6例患者存在严重的非特异性食管运动障碍，其特征为在食管下三分之二部位高达80%的波未传导或振幅极低。3例患者表现出一种测压紊乱，其特征为食管远端三分之一部位出现运动亢进的蠕动波。1例患者食管运动动力学改变，其特征为食管下三分之二部位80%的吞咽复合体由原发性同步波形成，随后在50%的病例中出现继发性蠕动波，其持续时间和振幅正常。其余2例患者食管动力正常。食管上括约肌未显示改变，10例患者食管下括约肌张力的测压评估结果正常，2例有轻度低血压。在出现食管运动障碍的9例患者中的7例，采用丙酸氟替卡松进行类固醇食管灌洗治疗，之后再次进行食管测压，结果显示一旦吞咽困难、内镜病变和组织病理学改变消失，运动障碍明显改善。
文献中描述了61例接受食管测压研究的食管黏膜嗜酸性粒细胞浸润病例，其中60.6%显示出不同类型测压改变的证据，主要具有痉挛或高收缩性特征。尽管我们的6例病例显示蠕动非常不足，波幅极低或未传导，另外3例记录到高振幅蠕动波。运动障碍随着黏膜嗜酸性粒细胞浸润的消失而平行改善。这些数据表明，嗜酸性食管炎中的运动障碍是食管嗜酸性粒细胞浸润的结果，在吞咽困难的鉴别诊断中应予以考虑。这些测压改变可被视为原发性非特异性疾病，并归入“无效食管动力”组。
