Department of Medicine, The Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611-2951, USA.
Gastroenterology. 2011 Aug;141(2):469-75. doi: 10.1053/j.gastro.2011.04.058. Epub 2011 May 6.
The manometric diagnosis of distal esophageal spasm (DES) uses "simultaneous contractions" as a defining criterion, ignoring the concept of short latency distal contractions as an important feature. Our aim was to apply standardized metrics of contraction velocity and latency to high-resolution esophageal pressure topography (EPT) studies to refine the diagnosis of DES.
Two thousand consecutive EPT studies were analyzed for contractile front velocity (CFV) and distal latency to identify patients potentially having DES. Normal limits for CFV and distal latency were established from 75 control subjects. Clinical data of patients with reduced distal latency and/or rapid CFV were reviewed.
Of 1070 evaluable patients, 91 (8.5%) had a high CFV and/or low distal latency. Patients with only rapid contractions (n = 186 [17.4%] using conventional manometry criteria; n = 85 [7.9%] using EPT criteria) were heterogeneous in diagnosis and symptoms, with the majority ultimately categorized as weak peristalsis or normal. In contrast, 96% of patients with premature contraction had dysphagia, and all (n = 24; 2.2% overall) were ultimately managed as spastic achalasia or DES.
The current DES diagnostic paradigm focused on "simultaneous contractions" identifies a large heterogeneous set of patients, most of whom do not have a clinical syndrome suggestive of esophageal spasm. Incorporating distal latency into the diagnostic algorithm of EPT studies improves upon this by isolating disorders of homogeneous pathophysiology: DES with short latency and spastic achalasia. We hypothesize that prioritizing measurement of distal latency will refine the management of these disorders, recognizing that outcomes trials are necessary.
食管动力障碍的测压诊断采用“同时收缩”作为定义标准，忽略了短潜伏期远端收缩作为一个重要特征的概念。我们的目的是应用收缩速度和潜伏期的标准化指标对高分辨率食管测压图（EPT）研究进行分析，以完善食管动力障碍的诊断。
对 2000 例连续的 EPT 研究进行收缩前沿速度（CFV）和远端潜伏期的分析，以确定可能患有食管动力障碍的患者。从 75 名对照受试者中确定 CFV 和远端潜伏期的正常范围。回顾具有缩短的远端潜伏期和/或快速 CFV 的患者的临床数据。
在 1070 例可评估的患者中，有 91 例（8.5%）的 CFV 较高和/或远端潜伏期较低。只有快速收缩的患者（使用常规测压标准的患者为 186 例[17.4%]；使用 EPT 标准的患者为 85 例[7.9%]）在诊断和症状上存在异质性，大多数最终被归类为微弱蠕动或正常蠕动。相比之下，96%的过早收缩患者存在吞咽困难，所有（n = 24；总体占 2.2%）最终被诊断为痉挛性失弛缓症或食管动力障碍。
目前以“同时收缩”为重点的食管动力障碍诊断范式，确定了一组异质性较大的患者，其中大多数患者没有提示食管痉挛的临床综合征。将远端潜伏期纳入 EPT 研究的诊断算法，可以通过分离出具有同质病理生理学的疾病来改善这一情况：即具有短潜伏期的食管动力障碍和痉挛性失弛缓症。我们假设优先测量远端潜伏期将改善这些疾病的管理，认识到需要进行结局试验。
