Department of Gastroenterology & Hepatology, Academic Medical Center, Amsterdam, The Netherlands.
Gastroenterology. 2012 Aug;143(2):328-35. doi: 10.1053/j.gastro.2012.04.048. Epub 2012 May 2.
BACKGROUND & AIMS: Many patients with persistent dysphagia and regurgitation after therapy have low or no lower esophageal sphincter (LES) pressure. Distensibility of the esophagogastric junction (EGJ) largely determines esophageal emptying. We investigated whether assessment of the distensibility of the EGJ is a better and more integrated parameter than LES pressure for determining efficacy of treatment for patients with achalasia.
We measured distensibility of the EGJ using an endoscopic functional luminal imaging probe (EndoFLIP) in 15 healthy volunteers (controls; 8 male; age, 40 ± 4.1 years) and 30 patients with achalasia (16 male; age, 51 ± 3.1 years). Patients were also assessed by esophageal manometry and a timed barium esophagogram. Symptom scores were assessed using the Eckardt score, with a score <4 indicating treatment success. The effect of initial and additional treatment on distensibility and symptoms was evaluated in 7 and 5 patients, respectively.
EGJ distensibility was significantly reduced in untreated patients with achalasia compared with controls (0.7 ± 0.9 vs 6.3 ± 0.7 mm(2)/mm Hg; P < .001). In patients with achalasia, EGJ distensibility correlated with esophageal emptying (r = -0.72; P < .01) and symptoms (r = 0.61; P < .01) and was significantly increased with treatment. EGJ distensibility was significantly higher in patients successfully treated (Eckardt score <3) compared with those with an Eckardt score >3 (1.6 ± 0.3 vs 4.4 ± 0.5 mm(2)/mm Hg; P = .001). Even when LES pressure was low, EGJ distensibility could be reduced, which was associated with impaired emptying and recurrent symptoms.
EGJ distensibility is impaired in patients with achalasia and, in contrast to LES pressure, is associated with esophageal emptying and clinical response. Assessment of EGJ distensibility by EndoFLIP is a better parameter than LES pressure for evaluating efficacy of treatment for achalasia.
许多经治疗后仍存在持续性吞咽困难和反流的患者食管下括约肌（LES）压力较低或无压力。食管胃结合部（EGJ）的可扩张性在很大程度上决定了食管排空。我们研究了评估 EGJ 可扩张性是否比 LES 压力更能作为确定贲门失弛缓症患者治疗效果的更好和更综合的参数。
我们使用内镜下功能性腔内成像探头（EndoFLIP）测量了 15 名健康志愿者（对照组；8 名男性；年龄 40 ± 4.1 岁）和 30 名贲门失弛缓症患者（16 名男性；年龄 51 ± 3.1 岁）的 EGJ 可扩张性。还通过食管测压和时间分辨钡餐食管造影评估了患者的症状。采用 Eckardt 评分评估症状评分，评分<4 表示治疗成功。分别评估了 7 名和 5 名初始治疗和附加治疗对可扩张性和症状的影响。
未经治疗的贲门失弛缓症患者的 EGJ 可扩张性明显低于对照组（0.7 ± 0.9 比 6.3 ± 0.7 mm²/mmHg；P<0.001）。在贲门失弛缓症患者中，EGJ 可扩张性与食管排空（r = -0.72；P<0.01）和症状（r = 0.61；P<0.01）相关，且经治疗后明显增加。Eckardt 评分<3 的患者的 EGJ 可扩张性明显高于 Eckardt 评分>3 的患者（1.6 ± 0.3 比 4.4 ± 0.5 mm²/mmHg；P=0.001）。即使 LES 压力较低，EGJ 可扩张性也可能降低，这与排空受损和症状复发相关。
贲门失弛缓症患者的 EGJ 可扩张性受损，与 LES 压力不同，与食管排空和临床反应相关。通过 EndoFLIP 评估 EGJ 可扩张性是评估贲门失弛缓症治疗效果的更好参数，优于 LES 压力。
