Haack Horst-Gunter, Hansen Ross-David, Malcolm Allison, Kellow John-Edward
Department of Gastroenterology, Gastrointestinal Investigation Unit, Royal North Shore Hospital, University of Sydney, Australia.
World J Gastroenterol. 2008 Jun 21;14(23):3719-24. doi: 10.3748/wjg.14.3719.
To compare the demographic and clinical features of different manometric subsets of ineffective oesophageal motility (IOM; defined as > or = 30% wet swallows with distal contractile amplitude < 30 mmHg), and to determine whether the prevalence of gastro-oesophageal reflux differs between IOM subsets.
Clinical characteristics of manometric subsets were determined in 100 IOM patients (73 female, median age 58 years) and compared to those of 100 age-and gender-matched patient controls with oesophageal symptoms, but normal manometry. Supine oesophageal manometry was performed with an eight-channel DentSleeve water-perfused catheter, and an ambulatory pH study assessed gastro-oesophageal reflux.
Patients in the IOM subset featuring a majority of low-amplitude simultaneous contractions (LASC) experienced less heartburn (prevalence 26%), but more dysphagia (57%) than those in the IOM subset featuring low-amplitude propagated contractions (LAP; heartburn 70%, dysphagia 24%; both P < or = 0.01). LASC patients also experienced less heartburn and more dysphagia than patient controls (heartburn 68%, dysphagia 11%; both P < 0.001). The prevalence of heartburn and dysphagia in IOM patients featuring a majority of non-transmitted sequences (NT) was 54% (P = 0.04 vs LASC) and 36% (P < 0.01 vs controls), respectively. No differences in age and gender distribution, chest pain prevalence, acid exposure time (AET) and symptom/reflux association existed between IOM subsets, or between subsets and controls.
IOM patients with LASC exhibit a different symptom profile to those with LAP, but do not differ in gastro-oesophageal reflux prevalence. These findings raise the possibility of different pathophysiological mechanisms in IOM subsets, which warrants further investigation.
比较无效食管动力（IOM；定义为≥30%的湿吞咽时远端收缩幅度<30 mmHg）不同测压亚组的人口统计学和临床特征，并确定胃食管反流的患病率在IOM亚组之间是否存在差异。
在100例IOM患者（73例女性，中位年龄58岁）中确定测压亚组的临床特征，并与100例年龄和性别匹配、有食管症状但测压正常的患者对照进行比较。使用八通道DentSleeve水灌注导管进行仰卧位食管测压，动态pH监测评估胃食管反流。
以多数低幅度同步收缩（LASC）为特征的IOM亚组患者烧心症状较少（患病率26%），但吞咽困难症状比以低幅度推进性收缩（LAP）为特征的IOM亚组患者更多（57%）（烧心70%，吞咽困难24%；P均≤0.01）。LASC患者烧心症状也比患者对照少，吞咽困难症状更多（烧心68%，吞咽困难11%；P均<0.001）。以多数非传导性序列（NT）为特征的IOM患者烧心和吞咽困难的患病率分别为54%（与LASC相比，P = 0.04）和36%（与对照相比，P < 0.01）。IOM亚组之间，或亚组与对照之间在年龄和性别分布、胸痛患病率、酸暴露时间（AET）以及症状/反流相关性方面均无差异。
具有LASC的IOM患者与具有LAP的患者症状表现不同，但胃食管反流患病率无差异。这些发现提示IOM亚组可能存在不同的病理生理机制，值得进一步研究。
