Pandolfino John E, Ghosh Sudip K, Rice John, Clarke John O, Kwiatek Monika A, Kahrilas Peter J
Department of Medicine, The Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611, USA.
Am J Gastroenterol. 2008 Jan;103(1):27-37. doi: 10.1111/j.1572-0241.2007.01532.x. Epub 2007 Sep 26.
This study aimed to devise a scheme for the systematic analysis of esophageal high-resolution manometry (HRM) studies displayed using topographic plotting.
A total of 400 patients and 75 control subjects were studied with a 36-channel HRM assembly. Studies were analyzed in a stepwise fashion for: (a) the adequacy of deglutitive esophagogastric junction (EGJ) relaxation, (b) the presence and propagation characteristics of distal esophageal persitalsis, and (c) an integral of the magnitude and span of the distal esophageal contraction.
Two strengths of pressure topography plots compared to conventional manometric recordings were: (a) the ability to delineate the spatial limits, vigor, and integrity of individual contractile segments along the esophagus, and (b) the ability to distinguish between loci of compartmentalized intraesophageal pressurization and rapidly propagated contractions. Making these distinctions objectified the identification of distal esophageal spasm (DES), vigorous achalasia, functional obstruction, and nutcracker esophagus subtypes. Applying these distinctions made the diagnosis of spastic disorders quite rare: (a) DES in 1.5% patients, (b) vigorous achalasia in 1.5%, and (c) a newly defined entity, spastic nutcracker, in 1.5%.
We developed a systematic approach to analyzing esophageal motility using HRM and pressure topography plots. The resultant scheme is consistent with conventional classifications with the caveats that: (a) hypercontractile conditions are more specifically defined, (b) distinctions are made between rapidly propagated contractions and compartmentalized esophageal pressurization, and (c) there is no "nonspecific esophageal motor disorder" classification. We expect that pressure topography analysis, with its well-defined functional implications, will prove valuable in the clinical management of esophageal motility disorders.
本研究旨在设计一种方案，用于系统分析采用地形图绘制展示的食管高分辨率测压（HRM）研究。
使用36通道HRM装置对总共400例患者和75名对照受试者进行研究。对研究进行逐步分析，内容包括：（a）吞咽时食管胃交界（EGJ）松弛的充分性，（b）食管远端蠕动的存在及传播特征，以及（c）食管远端收缩的幅度和跨度积分。
与传统测压记录相比，压力地形图有两个优点：（a）能够描绘食管沿线各个收缩节段的空间界限、强度和完整性，以及（b）能够区分食管内局部加压部位和快速传播的收缩。进行这些区分使食管远端痉挛（DES）、强力型贲门失弛缓症、功能性梗阻和胡桃夹食管亚型的识别更加客观。应用这些区分使痉挛性疾病的诊断相当少见：（a）DES在1.5%的患者中出现，（b）强力型贲门失弛缓症在1.5%的患者中出现，以及（c）一种新定义的实体，痉挛性胡桃夹食管，在1.5%的患者中出现。
我们开发了一种使用HRM和压力地形图分析食管动力的系统方法。所得方案与传统分类一致，但有以下注意事项：（a）对高收缩状态进行了更具体的定义，（b）区分了快速传播的收缩和食管局部加压，以及（c）没有“非特异性食管运动障碍”分类。我们预计，具有明确功能意义的压力地形图分析在食管动力障碍的临床管理中将被证明是有价值的。
