Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO, USA.
Neurogastroenterol Motil. 2013 Feb;25(2):99-133. doi: 10.1111/nmo.12071.
Esophageal motor function is highly coordinated between central and enteric nervous systems and the esophageal musculature, which consists of proximal skeletal and distal smooth muscle in three functional regions, the upper and lower esophageal sphincters, and the esophageal body. While upper endoscopy is useful in evaluating for structural disorders of the esophagus, barium esophagography, radionuclide transit studies, and esophageal intraluminal impedance evaluate esophageal transit and partially assess motor function. However, esophageal manometry is the test of choice for the evaluation of esophageal motor function. In recent years, high-resolution manometry (HRM) has streamlined the process of acquisition and display of esophageal pressure data, while uncovering hitherto unrecognized esophageal physiologic mechanisms and pathophysiologic patterns. New algorithms have been devised for analysis and reporting of esophageal pressure topography from HRM. The clinical value of HRM extends to the pediatric population, and complements preoperative evaluation prior to foregut surgery. Provocative maneuvers during HRM may add to the assessment of esophageal motor function. The addition of impedance to HRM provides bolus transit data, but impact on clinical management remains unclear. Emerging techniques such as 3-D HRM and impedance planimetry show promise in the assessment of esophageal sphincter function and esophageal biomechanics.
食管运动功能高度协调于中枢和肠神经系统以及食管肌肉，其由近端骨骼肌和远端平滑肌组成，分为三个功能区，即食管上括约肌、食管下括约肌和食管体。虽然上消化道内镜检查在评估食管结构异常方面有用，但钡餐食管造影、放射性核素通过研究和食管腔内阻抗检查可评估食管通过情况并部分评估运动功能。然而，食管测压是评估食管运动功能的首选检查。近年来，高分辨率测压（HRM）简化了食管压力数据的采集和显示过程，同时揭示了以前未被认识的食管生理机制和病理生理模式。已经设计了用于分析和报告 HRM 食管压力地形图的新算法。HRM 的临床价值延伸至儿科人群，并补充了前肠手术前的术前评估。在 HRM 期间进行的激发操作可能会增加对食管运动功能的评估。将阻抗添加到 HRM 中可提供充盈通过数据，但对临床管理的影响尚不清楚。新兴技术，如 3-D HRM 和阻抗平面测量，在评估食管括约肌功能和食管生物力学方面显示出前景。
