Radulovic M, Schilero G J, Yen C, Bauman W A, Wecht J M, Ivan A, La Fountaine M F, Korsten M A
Rehabilitation Research & Development Service, National Center of Excellence for the Medical Consequences of Spinal Cord Injury, The James J. Peters VA Medical Center, Bronx, USA.
Medical Service, The James J. Peters VA Medical Center, Bronx, USA.
Dis Esophagus. 2015 Oct;28(7):699-704. doi: 10.1111/dote.12272. Epub 2014 Sep 16.
The effects of spinal cord injury (SCI) on esophageal motility are largely unknown. Furthermore, due to the complete or partial loss of sensory innervation to the upper gastrointestinal tract, a symptom-based diagnosis of esophageal dysmotility is problematic in the SCI population. To determine the prevalence and characterize the type of motility disorders observed in persons with chronic SCI compared with that of able-bodied (AB) controls based on esophageal pressure topography isometrics acquired by high-resolution manometry and categorized by application of the Chicago Classification. High-resolution manometry of the esophagus was performed in 39 individuals: 14 AB, 12 with paraplegia (level of injury between T4-T12) and 13 with tetraplegia (level of injury between C5-C7). A catheter containing multiple pressure sensors arranged at 360° was introduced into the esophagi of subjects at a distance that allowed visualization of both the upper esophageal sphincters (UES) and lower esophageal sphincters (LES). After a period to acquire pressures at baseline, subjects were asked to perform 10 wet swallows with 5-mL boluses of isotonic saline while esophageal pressure and impedance were being recorded. No significant differences were noted for gender, age, or body mass index between AB and SCI groups. Twenty-one of 25 (84%) subjects with SCI had at least one motility abnormality: 12% with Type II achalasia, 4% with Type III achalasia, 20% with esophagogastric junction outflow obstruction, 4% with the hypercontractile esophagus, and 48% with peristaltic abnormalities (weak peristalsis with small or large defects or frequent failed peristalsis). In contrast, only 7% (1 out of 14) of the AB subjects had any type of esophageal motility disorder. Despite the lack of subjective complaints and clinical awareness, esophageal dysmotility appears to be a highly prevalent condition in persons with SCI. The use of new and improved techniques, as well as a more stringent classification system, permitted the identification of the presence of nonspecific motility disorders in almost all SCI subjects, including four individuals who were previously undiagnosed with achalasia. Future work in persons with SCI is required to clarify the clinical impact of this observation and to study potential associations between esophageal dysmotility, gastroesophageal reflux disease, and pulmonary function. An increased awareness of esophageal dysfunction in the SCI population may lead to the development of new clinical guidelines for the diagnosis, prevention, and treatment of these largely unrecognized disorders.
脊髓损伤（SCI）对食管动力的影响在很大程度上尚不清楚。此外，由于上消化道感觉神经支配的完全或部分丧失，基于症状对SCI人群的食管动力障碍进行诊断存在问题。基于高分辨率测压获得的食管压力地形图等长运动测量，并应用芝加哥分类法进行分类，以确定慢性SCI患者与健全（AB）对照相比观察到的动力障碍的患病率并对其类型进行特征描述。对39名个体进行了食管高分辨率测压：14名健全者，12名截瘫患者（损伤平面在T4 - T12之间）和13名四肢瘫患者（损伤平面在C5 - C7之间）。将一个装有多个360°排列的压力传感器的导管插入受试者食管中一个能同时观察到食管上括约肌（UES）和食管下括约肌（LES）的位置。在获取基线压力一段时间后，要求受试者在记录食管压力和阻抗的同时，用5毫升等渗盐水进行10次湿咽。AB组和SCI组在性别、年龄或体重指数方面未发现显著差异。25名SCI受试者中有21名（84%）至少有一种动力异常：12%为II型贲门失弛缓症，4%为III型贲门失弛缓症，20%为食管胃交界流出道梗阻，4%为高收缩性食管，48%为蠕动异常（蠕动减弱伴小或大的缺损或频繁的蠕动失败）。相比之下，AB组受试者中只有7%（14名中的1名）有任何类型的食管动力障碍。尽管缺乏主观症状和临床意识，但食管动力障碍在SCI患者中似乎是一种高度普遍的情况。使用新的和改进的技术以及更严格的分类系统，使得几乎所有SCI受试者中都能识别出非特异性动力障碍的存在，包括4名先前未被诊断为贲门失弛缓症的个体。未来需要对SCI患者开展工作，以阐明这一观察结果的临床影响，并研究食管动力障碍、胃食管反流病和肺功能之间的潜在关联。提高对SCI人群食管功能障碍的认识可能会促使制定针对这些大多未被认识疾病的诊断、预防和治疗的新临床指南。
