Howard P J, Maher L, Pryde A, Heading R C
Department of Medicine, Royal Infirmary of Edinburgh.
Gut. 1991 Nov;32(11):1264-9. doi: 10.1136/gut.32.11.1264.
Conventional oesophageal manometry is seldom accompanied by symptoms and may indeed be normal in patients with a history of dysphagia. We have recently shown that oesophageal manometry during eating may be helpful in the evaluation of patients with dysphagia but there has been little systematic comparison of fed oesophageal motor patterns with conventional clinical manometry. Oesophageal manometry in response to water swallows and during eating was therefore examined in 58 consecutive patients who had been referred for clinical oesophageal function studies. The patients were divided into three groups according to the percentage of peristaltic activity during conventional manometry: group 1 (n = 21) had 100% peristalsis; group 2 (n = 29) had 1-99% peristalsis and group 3 (n = 8) were aperistaltic. All the patients in group 3 had achalasia and remained aperistaltic during eating, however, was less than with water swallows in both group 1 (53% compared with 100%) and group 2 (49% compared with 82.3%) patients. Synchronous contractions and non-conducted swallows were correspondingly increased during eating. Although there was a significant correlation between the amplitude of peristaltic contractions with water and bread in groups 1 and 2, mean peristaltic amplitudes were less with bread than with water swallows. The data show that there are substantial differences in the distal oesophageal motility patterns produced by water swallows and by eating. Conventional manometry with water swallows does not allow prediction of the fed oesophageal motility pattern, except in patients with achalasia.
传统食管测压很少伴有症状，对于有吞咽困难病史的患者，其结果甚至可能正常。我们最近发现，进食期间的食管测压可能有助于评估吞咽困难患者，但与传统临床测压相比，对进食时食管运动模式的系统比较较少。因此，我们对58例因临床食管功能研究而转诊的连续患者进行了饮水吞咽和进食期间的食管测压检查。根据传统测压期间蠕动活动的百分比，将患者分为三组：第1组（n = 21）蠕动活动为100%；第2组（n = 29）蠕动活动为1 - 99%；第3组（n = 8）无蠕动。第3组所有患者均患有贲门失弛缓症，进食期间仍无蠕动，不过，第1组（53% 对比100%）和第2组（49% 对比82.3%）患者进食时的蠕动活动低于饮水吞咽时。进食期间同步收缩和未传导吞咽相应增加。尽管第1组和第2组中饮水和进食面包时蠕动收缩幅度之间存在显著相关性，但进食面包时的平均蠕动幅度低于饮水吞咽时。数据表明，饮水吞咽和进食所产生的食管远端运动模式存在实质性差异。除贲门失弛缓症患者外，传统的饮水吞咽测压无法预测进食时的食管运动模式。
