Department of Gastroenterology and Hepatology, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, China.
World J Gastroenterol. 2013;19(14):2270-7. doi: 10.3748/wjg.v19.i14.2270.
To study non-cardiac chest pain (NCCP) in relation to ineffective esophageal motility (IEM) and rapid food intake.
NCCP patients with a self-reported habit of fast eating underwent esophageal manometry for the diagnosis of IEM. Telephone interviews identified eating habits of additional IEM patients. Comparison of manometric features was done among IEM patients with and without the habit of rapid food intake and healthy controls. A case study investigated the effect of 6-mo gum chewing on restoration of esophageal motility in an IEM patient. The Valsalva maneuver was performed in IEM patients and healthy controls to assess the compliance of the esophagus in response to abdominal pressure increase.
Although most patients diagnosed with NCCP do not exhibit IEM, remarkably, all 12 NCCP patients who were self-reporting fast eaters with a main complaint of chest pain (75.0%) had contraction amplitudes in the mid and distal esophagus that were significantly lower compared with healthy controls [(23.45 mmHg (95%CI: 14.06-32.85) vs 58.80 mmHg (95%CI: 42.56-75.04), P < 0.01 and 28.29 mmHg (95%CI: 21.77-34.81) vs 50.75 mmHg (95%CI: 38.44-63.05), P < 0.01, respectively)]. In 7 normal-eating IEM patients with a main complaint of sensation of obstruction (42.9%), the mid amplitude was smaller than in the controls [30.09 mmHg (95%CI: 19.48-40.70) vs 58.80 mmHg (95%CI: 42.56-75.04), P < 0.05]. There was no statistically significant difference in manometric features between the fast-eating and normal-eating groups. One NCCP patient who self-reported fast eating and was subsequently diagnosed with IEM did not improve with proton-pump inhibition but restored swallow-induced contractions upon 6-mo gum-chewing. The Valsalva maneuver caused a markedly reduced pressure rise in the mid and proximal esophagus in the IEM patients.
Habitual rapid food intake may lead to IEM. A prospective study is needed to validate this hypothesis. Gum-chewing might strengthen weakened esophageal muscles.
研究非心源性胸痛（NCCP）与无效食管动力（IEM）和快速进食之间的关系。
自我报告有快速进食习惯的 NCCP 患者接受食管测压以诊断 IEM。电话访谈确定了其他 IEM 患者的饮食习惯。比较了有和没有快速进食习惯的 IEM 患者和健康对照组之间的测压特征。一项病例研究调查了 6 个月咀嚼口香糖对 IEM 患者食管动力恢复的影响。在 IEM 患者和健康对照组中进行瓦尔萨尔瓦动作，以评估食管对腹部压力增加的顺应性。
尽管大多数诊断为 NCCP 的患者并未表现出 IEM，但值得注意的是，所有 12 名自我报告胸痛主要抱怨为快速进食的 NCCP 患者（75.0%）的中远端食管收缩幅度明显低于健康对照组[(23.45mmHg（95%CI：14.06-32.85）与 58.80mmHg（95%CI：42.56-75.04），P<0.01 和 28.29mmHg（95%CI：21.77-34.81）与 50.75mmHg（95%CI：38.44-63.05），P<0.01]）]。在 7 名主要抱怨梗阻感的正常进食 IEM 患者中（42.9%），中幅度小于对照组[30.09mmHg（95%CI：19.48-40.70）与 58.80mmHg（95%CI：42.56-75.04），P<0.05]。快速进食组和正常进食组之间的测压特征无统计学差异。一名自我报告快速进食并随后被诊断为 IEM 的 NCCP 患者质子泵抑制剂治疗无效，但咀嚼口香糖 6 个月后吞咽诱导收缩恢复。瓦尔萨尔瓦动作导致 IEM 患者中远端和近端食管的压力显著降低。
习惯性快速进食可能导致 IEM。需要前瞻性研究来验证这一假设。咀嚼口香糖可能会增强薄弱的食管肌肉。
