Department of Medicine, Division of Gastroenterology and Hepatology, The Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.
Neurogastroenterol Motil. 2012 Mar;24 Suppl 1:11-9. doi: 10.1111/j.1365-2982.2011.01829.x.
The assessment of the esophagogastric junction (EGJ) is the most challenging aspect of clinical esophageal manometry. Although conventional manometric systems can be optimized toward interrogating specific aspects of the EGJ, they are too limited in recording channels and/or fidelity for a comprehensive assessment. The technological advantages inherent in high resolution manometry (HRM) with esophageal pressure topography (EPT) analysis substantially change this equation providing a technology sufficiently robust to dynamically record the contractile activity within the EGJ with both good fidelity and good spatial resolution.
This review is an update on our understanding of the application of HRM and EPT to the analysis of EGJ function. With respect to sphincter relaxation, the integrated relaxation pressure (IRP) has proven to be a robust metric in differentiating intact from impaired EGJ relaxation. In the process, it revealed that impaired EGJ relaxation could occur not only in the setting of achalasia but also with other causes of EGJ outflow obstruction including hiatus hernia. The morphological description of the EGJ by EPT has also revealed not only a spectrum of abnormality ranging from an intact sphincter to overt herniation, but also the surprise finding of spontaneous conversion among sphincter configurations, emphasizing its dynamic nature. With respect to barrier function, preliminary data have refocused on the crural diaphragm as a key-differentiating feature between preserved and compromised function. Finally, although the accomplishments summarized above are substantial, much work remains to fully exploit the potential of EPT in the clinical characterization of the EGJ.
食管胃结合部（EGJ）的评估是临床食管测压中最具挑战性的方面。尽管传统的测压系统可以针对 EGJ 的特定方面进行优化，但它们在记录通道和/或保真度方面的限制太多，无法进行全面评估。具有食管压力地形图（EPT）分析的高分辨率测压（HRM）的技术优势从根本上改变了这一方程，提供了一种技术，该技术具有足够的稳健性，可以动态记录 EGJ 内的收缩活性，具有良好的保真度和良好的空间分辨率。
本文回顾了我们对 HRM 和 EPT 在 EGJ 功能分析中的应用的理解。就括约肌松弛而言，综合松弛压力（IRP）已被证明是区分完整和受损 EGJ 松弛的有力指标。在此过程中，它揭示了 EGJ 松弛受损不仅会发生在贲门失弛缓症中，还会发生在其他 EGJ 流出梗阻的原因，包括食管裂孔疝。EPT 对 EGJ 的形态描述不仅揭示了从完整括约肌到明显疝出的异常范围，还发现了括约肌构型之间自发转换的惊喜发现，强调了其动态性质。关于屏障功能，初步数据重新聚焦于膈脚作为功能正常和受损之间的关键鉴别特征。最后，尽管上述成就相当可观，但仍有许多工作要做，才能充分利用 EPT 在 EGJ 临床特征描述中的潜力。
