Pandolfino John E, Ghosh Sudip K, Lodhia Nilesh, Kahrilas Peter J
Departments of Medicine, The Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611, USA.
Am J Gastroenterol. 2008 Aug;103(8):1898-905. doi: 10.1111/j.1572-0241.2008.01913.x. Epub 2008 Jul 12.
Esophageal bolus clearance requires a preferential esophagogastric pressure gradient sustained for a sufficient period. We aimed to validate a high-resolution manometry (HRM) paradigm for predicting bolus clearance.
Twenty volunteers and 30 patients were studied with HRM during barium swallows with concurrent fluoroscopy. Simultaneous bolus domain pressure and esophagogastric junction (EGJ) obstruction pressure were plotted and flow permissive time was tallied during which the bolus domain pressure exceeded the EGJ obstruction pressure. Distal peristaltic integrity was assessed at incrementally increasing pressure isobaric contour thresholds from 15-40 mmHg. ROC analysis was performed to assess the sensitivity and specificity of cutoff values for flow permissive time and peristaltic amplitude for predicting incomplete clearance as verified fluoroscopically.
Flow permissive time < or =2.5 s had a sensitivity of 86% and specificity of 92% for predicting incomplete clearance. In contrast, a 30-mmHg peristaltic amplitude had a sensitivity of only 48% and specificity of 88%. Incomplete clearance was variably attributable to functional EGJ obstruction, hiatus hernia, or impaired peristalsis.
A detailed analysis of intraluminal pressure gradients in the distal esophagus and across the EGJ in the postdeglutitive period predicts esophageal bolus clearance with far greater accuracy than any threshold value of peristaltic amplitude.
食管团块清除需要维持足够时间的食管胃压力梯度。我们旨在验证一种用于预测团块清除的高分辨率测压法（HRM）模式。
对20名志愿者和30名患者在吞咽钡剂并同步进行荧光透视检查期间采用HRM进行研究。绘制团块区域压力和食管胃交界（EGJ）梗阻压力，并记录团块区域压力超过EGJ梗阻压力的流动允许时间。在15至40 mmHg的等压轮廓阈值逐渐增加时评估远端蠕动完整性。进行ROC分析以评估流动允许时间和蠕动幅度的临界值对预测荧光透视证实的不完全清除的敏感性和特异性。
流动允许时间≤2.5秒对预测不完全清除的敏感性为86%，特异性为92%。相比之下，蠕动幅度为30 mmHg时敏感性仅为48%，特异性为88%。不完全清除可不同程度地归因于功能性EGJ梗阻、食管裂孔疝或蠕动受损。
对吞咽后远端食管腔内压力梯度以及跨EGJ的压力梯度进行详细分析，预测食管团块清除的准确性远高于任何蠕动幅度阈值。
