*University of Iowa Carver College of Medicine and VAMC, Iowa City, IA †Medical College of Georgia, Georgia Regents University, Augusta, GA.
J Clin Gastroenterol. 2014 Mar;48(3):224-30. doi: 10.1097/MCG.0000000000000057.
Whether body position affects lower esophageal sphincter (LES) function and detection of hiatal hernia is unknown. Moreover, the yield of high-resolution esophageal pressure topography (HREPT) when compared with endoscopy for detection of hiatal hernia is unclear.
The aims of this study were to examine (a) the effects of body position (standing vs. supine) on LES function, and (b) to determine the diagnostic yield of HREPT and endoscopy for detection of hiatal hernia.
A total of 50 subjects underwent both HREPT and endoscopy. The manometric/topographic changes of LES were examined in both supine and standing positions. Endoscopy assessed presence and length of hiatal hernia. Diagnostic agreement was compared between HREPT and endoscopy.
The resting LES pressure was higher (P=0.0001), its mean length was longer (P=0.0003), and length of high-pressure zone was longer (P=0.0001) in the standing position compared with the supine position. HREPT detected twice as many subjects with hiatal hernia in standing (P=0.0001) compared with supine position or endoscopy with significant new diagnostic information (79%). Endoscopy detection rate (34%) was similar to supine manometry with good diagnostic agreement (77%) between HREPT and endoscopy. Hiatal hernia length was longer (P=0.0001) with HREPT in standing position compared with endoscopy.
Body position significantly affects in the LES function and its measurements. HREPT when performed on standing position offers the best yield for detection of hiatal hernia and is superior to endoscopy or supine manometry.
目前尚不清楚体位变化是否会影响食管下括约肌（LES）功能和食管裂孔疝（hiatal hernia）的检出，也不清楚高分辨率食管测压（HREPT）在检测食管裂孔疝方面与内镜检查的效果差异。
本研究旨在探讨（a）体位（站立位与仰卧位）变化对 LES 功能的影响，以及（b）HREPT 和内镜检查检测食管裂孔疝的诊断效能。
共 50 例受试者同时接受 HREPT 和内镜检查。检测并比较了 LES 在仰卧位和站立位时的测压/测压地形图变化。内镜评估食管裂孔疝的存在和长度。比较了 HREPT 和内镜检查的诊断一致性。
与仰卧位相比，站立位时 LES 静息压更高（P=0.0001），平均长度更长（P=0.0003），高压区长度更长（P=0.0001）。与仰卧位或内镜检查相比，HREPT 在站立位时能检出两倍以上的食管裂孔疝患者，且有显著的新诊断信息（79%）（P=0.0001）。内镜检查的检出率（34%）与仰卧位测压相似，HREPT 与内镜检查的诊断一致性较好（77%）。与内镜检查相比，站立位 HREPT 检测到的食管裂孔疝长度更长（P=0.0001）。
体位明显影响 LES 功能及其检测结果。站立位 HREPT 检测食管裂孔疝的效果最好，优于内镜检查或仰卧位测压。
