Neurogastroenterology & Motility Clinic, University Hospital Leuven, Leuven, Belgium.
Neurogastroenterol Motil. 2014 Jan;26(1):69-76. doi: 10.1111/nmo.12228. Epub 2013 Sep 4.
Pneumatic dilation of the lower esophageal sphincter (LES) in achalasia has an unappreciated effect on upper esophageal sphincter (UES) function. We studied UES pressure patterns at baseline and alterations in UES parameters resulting from therapy.
High-resolution manometry (HRM) tracings from 50 achalasia patients, seen at a tertiary center between January 2009 and July 2011, were reviewed. Manometric parameters studied were (i) LES: resting pressure (restP), 4-second integrated relaxation pressure (IRP4); (ii) UES: resting pressure (restP), minimal relaxation pressure (MRP), peak pressure (PP), relaxation interval (RI), intrabolus pressure (IBP), and deglutitive sphincter resistance (DSR). Mixed models analyses with LES and UES parameters as dependent variables and treatment stage as within-subject independent variable of interest were used. Correlations between treatment-induced changes in LES, UES, and esophageal body (EB) parameters were performed.
Pre- and posttreatment HRM tracings were available from 50 patients (mean age 52.7 ± 18.6 years, 29 men). Upper esophageal sphincter parameters MRP (17.9 ± 1.2 vs 15.2 ± 0.9 mmHg; p = 0.02) and IBP (31.5 ± 1.5 vs 27.4 ± 1.2 mmHg; p = 0.009) were significantly reduced after initial balloon dilation and this effect was significant in type II achalasia (p = 0.002 and p = 0.0006). Peak pressure, RI, and DSR were not. The therapeutic effect on LES IRP4 correlated significantly with the change in UES MRP, statistically mediated by the change in EB deglutitive pressure (p = 0.004 and p = 0.0002).
CONCLUSIONS & INFERENCES: We present the first HRM study demonstrating that pneumatic dilation of the LES affects intraesophageal and UES pressures in patients with achalasia.
贲门失弛缓症患者的下食管括约肌（LES）气动扩张对食管上括约肌（UES）功能有未被认识到的影响。我们研究了基线时UES 压力模式以及治疗引起的 UES 参数变化。
回顾 2009 年 1 月至 2011 年 7 月在三级中心就诊的 50 例贲门失弛缓症患者的高分辨率测压（HRM）描记图。研究的测压参数包括：（i）LES：静息压（restP），4 秒积分松弛压（IRP4）；（ii）UES：静息压（restP），最小松弛压（MRP），峰值压（PP），松弛间隔（RI），腔内压（IBP）和吞咽括约肌阻力（DSR）。采用混合模型分析，将 LES 和 UES 参数作为因变量，以治疗阶段为感兴趣的个体内自变量。对治疗引起的 LES、UES 和食管体（EB）参数变化之间的相关性进行了分析。
50 例患者（平均年龄 52.7±18.6 岁，29 名男性）的治疗前后 HRM 描记图均可用。初始球囊扩张后，UES 压力参数 MRP（17.9±1.2 与 15.2±0.9mmHg；p=0.02）和 IBP（31.5±1.5 与 27.4±1.2mmHg；p=0.009）明显降低，在 II 型贲门失弛缓症中效果显著（p=0.002 和 p=0.0006）。PP、RI 和 DSR 没有变化。UES MRP 的治疗效果与 LES IRP4 的变化显著相关，统计学上由 EB 吞咽压的变化介导（p=0.004 和 p=0.0002）。
我们首次进行 HRM 研究，证明 LES 的气动扩张会影响贲门失弛缓症患者的食管内和 UES 压力。
