Department of Medicine, The Feinberg School of Medicine, Northwestern University, Chicago, IL 60611-2951, USA.
Neurogastroenterol Motil. 2012 Oct;24(10):e509-16. doi: 10.1111/j.1365-2982.2012.02001.x. Epub 2012 Aug 16.
Although, the current protocol for high resolution manometry (HRM) using the Chicago Classification is based on the supine posture, some practitioners prefer a sitting posture. Our aims were to establish normative esophageal pressure topography data for the sitting position and to determine the effect of applying those norms to Chicago Classification diagnoses.
Esophageal pressure topography studies including test swallows in both a supine and sitting position of 75 healthy volunteers and 120 patients were reviewed. Integrated relaxation pressure (IRP), distal contractile integral (DCI), contractile front velocity (CFV), and distal latency were measured and compared between postures. Normative ranges were established from the healthy volunteers and the effect of applying sitting normative values to the patients was analyzed.
Normative values of IRP, DCI, and CFV all decreased significantly in the sitting posture. Applying normative sitting metrics to patient studies [27% reduction in IRP (15 to 11 mmHg), 69% reduction in DCI (8000-2500 mmHg-s-cm)] reclassified 13/120 (11%) patients as having abnormal esophagogastric junction relaxation and 26/120 (22%) as hypercontractile. Three patients with an abnormal supine IRP normalized when sitting with elimination of a vascular artifact.
CONCLUSIONS & INFERENCES: Clinical HRM studies should include both a supine and sitting position to minimize misdiagnoses attributable to anatomical factors. However, until outcome studies demonstrating the significance of isolated abnormalities of IRP or DCI in the sitting position are available, the Chicago Classification of esophageal motility disorders should continue to be based on supine swallows using normative data from the supine posture.
尽管目前使用芝加哥分类的高分辨率测压法（HRM）的方案基于仰卧位，但一些从业者更喜欢坐姿。我们的目的是建立坐姿食管压力地形图的正常参考值，并确定将这些正常值应用于芝加哥分类诊断的效果。
回顾了 75 名健康志愿者和 120 名患者的仰卧位和坐姿食管压力地形图研究，包括测试吞咽。测量并比较了两种体位下的整合松弛压（IRP）、远端收缩积分（DCI）、收缩前沿速度（CFV）和远端潜伏期。从健康志愿者中建立正常参考范围，并分析将坐姿正常参考值应用于患者的效果。
IRP、DCI 和 CFV 的正常参考值在坐姿时均显著降低。将坐姿正常参考值应用于患者研究[IRP 降低 27%（15 至 11mmHg），DCI 降低 69%（8000 至 2500mmHg-s-cm）]，重新分类了 13/120（11%）名患者为食管胃交界处松弛异常，26/120（22%）为高收缩性。3 名仰卧位 IRP 异常的患者在坐姿时正常化，消除了血管伪影。
临床 HRM 研究应包括仰卧位和坐姿，以尽量减少因解剖因素导致的误诊。然而，在证明坐姿时孤立的 IRP 或 DCI 异常的意义的结果研究可用之前，食管动力障碍的芝加哥分类应继续基于仰卧位的正常参考值进行，使用仰卧位的正常参考值。
