Gao F, Gao Y, Hobson A R, Huang W N, Shang Z M
Digestive Department, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
Gastrointestinal Physiology Department, The Functional Gut Clinic, London, UK.
Dis Esophagus. 2016 Apr;29(3):267-72. doi: 10.1111/dote.12320. Epub 2014 Dec 17.
The aim of this study was to investigate the normal high-resolution manometry and impedance (HRiM) values in the supine and sitting positions in the population of Northern China, and to investigate the influence of different body positions and bolus consistency on esophageal HRiM findings. In this study, healthy volunteers in the supine position underwent esophageal HRiM examination of 10 swallows of 5 mL normal saline solution and 10 swallows of 5 mL synthetic gel of known viscosity, and in the sitting position of an additional five swallows of a synthetic gel of known viscosity. Total bolus transit time (TBTT), complete bolus transit rate (CBTR), distal contractile integral (DCI), distal esophageal amplitude (DEA), and integrated relaxation pressure (IRP) were measured. Sixty-two healthy volunteers were examined in the supine position and 45 of these performed additional swallows of the viscous gel in the sitting position. In the supine position, normal values for swallowing the liquid and viscous boli were as follows: TBTT 6.9 ± 0.9 and 8.0 ± 1.2 s (P < 0.001), CBTR 90.3 ± 14.0 and 77.9 ± 20.3% (P < 0.001), DCI 1891.5 ± 1131.9 and 1967.8 ± 1140.1 mmHg.s.cm (P = 0.227), DEA 95.3 ± 35.4 and 98.7 ± 37.5 mmHg (P = 0.148), and IRP 10.4 ± 4.9 and 9.0 ± 4.2 mmHg (P < 0.001), respectively. For swallows of the viscous boli in the sitting position, TBTT, DCI, DEA, and IRP were significantly decreased, while CBTR was unchanged (P = 0.075). Normal HRiM values of the population of Northern China were established. Esophageal transit times of viscous boli were significantly slower, more often incomplete and produced less normal peristalsis in the supine position than swallows of liquid boli. Independent reference values for different manometric systems, body positions, and population need to be established before clinical application.
本研究旨在调查中国北方人群仰卧位和坐位时的正常高分辨率测压和阻抗（HRiM）值，并研究不同体位和团块黏稠度对食管HRiM结果的影响。在本研究中，健康志愿者在仰卧位时接受了食管HRiM检查，分别吞咽10次5毫升生理盐水溶液和10次5毫升已知黏度的合成凝胶，在坐位时额外吞咽5次已知黏度的合成凝胶。测量总团块通过时间（TBTT）、完全团块通过率（CBTR）、远端收缩积分（DCI）、食管远端振幅（DEA）和综合松弛压（IRP）。62名健康志愿者在仰卧位接受检查，其中45名在坐位额外吞咽了黏稠凝胶。在仰卧位时，吞咽液体和黏稠团块的正常值如下：TBTT分别为6.9±0.9和8.0±1.2秒（P<0.001），CBTR分别为90.3±14.0和77.9±20.3%（P<0.001），DCI分别为1891.5±1131.9和1967.8±1140.1mmHg·s·cm（P=0.227），DEA分别为95.3±35.4和98.7±37.5mmHg（P=0.148），IRP分别为10.4±4.9和9.0±4.2mmHg（P<0.001）。对于坐位时吞咽黏稠团块，TBTT、DCI、DEA和IRP显著降低，而CBTR无变化（P=0.075）。建立了中国北方人群的正常HRiM值。与吞咽液体团块相比，仰卧位时吞咽黏稠团块的食管通过时间显著减慢，更常不完全通过，且蠕动正常的情况更少。在临床应用前，需要为不同的测压系统、体位和人群建立独立参考值。
