Martín-Domínguez Verónica, Pérez-Fernández María Teresa, Marinero Almudena, Jusué-Irurita Vanesa, Caldas María, Santander Cecilio
Rev Esp Enferm Dig. 2015 May;107(5):274-9.
Hypercontractile esophagus (HE) is a primary hypercontractile disorder of the esophageal musculature not frequently seen in the general population. It is characterized by the presence of at least one contraction with a very high amplitude and duration (DCI > 8,000 mmHg/s/cm) in patients with esophageal symptoms. The aim of our study was to assess the clinical context and manometric characteristics in patients with HE using highresolution manometry (HRM).
We thoroughly reviewed the clinical features and manometric findings of a total of 720 patients with esophageal symptoms that were attended in the Department of Gastroenterology of our hospital between June 2011 and June 2013.
We found seven patients that met criteria for HE according to the Chicago Classification (2012). All of the patients were women (100%). Mean age was 64 years old. Most frequent symptoms were: Chest pain, dysphagia and heartburn.In one patient (14%) the HE was related to a gastroesophageal reflux disease (GERD) and gastroesophageal junction (GEJ) outflow obstruction. Three patients (43%) had more than one hypercontractile contraction in the study. Four patient (57%) hade multipeaked pattern (Jackhammer esophagus) and y two of them were synchronized with respiration. Two patients (29%) were diagnosed with hiatus hernias. Integrated relaxation pressure (IRP) was not higher in hypercontractile contractions than in normal contractions. Only one patient presented a slight alteration of the relaxation (IRP-4s = 15 mmHg) with normal peristalsis, GEJ outflow obstruction and not multipeakeded pattern. One patient presented pathological acid exposure (PAE) in 24-hours pH-metry.
HE is a rare disorder and HRM is essential for its correct diagnosis and characterization. The treatment of HE should achieve the disappearance or at least improvement of the patient´s symptoms and avoid unnecessary diagnostic testing.
高收缩性食管（HE）是一种食管肌肉组织的原发性高收缩性疾病，在普通人群中并不常见。其特征是食管有症状的患者至少存在一次振幅和持续时间非常高的收缩（DCI > 8,000 mmHg/s/cm）。我们研究的目的是使用高分辨率测压法（HRM）评估HE患者的临床情况和测压特征。
我们全面回顾了2011年6月至2013年6月期间在我院胃肠病科就诊的720例有食管症状患者的临床特征和测压结果。
根据芝加哥分类法（2012年），我们发现7例符合HE标准的患者。所有患者均为女性（100%）。平均年龄为64岁。最常见的症状是胸痛、吞咽困难和烧心。1例患者（14%）的HE与胃食管反流病（GERD）和胃食管交界处（GEJ）流出道梗阻有关。3例患者（43%）在研究中有不止一次高收缩性收缩。4例患者（57%）呈多峰模式（胡桃夹食管），其中2例与呼吸同步。2例患者（29%）被诊断为食管裂孔疝。高收缩性收缩时的综合松弛压（IRP）并不高于正常收缩时的IRP。只有1例患者在蠕动正常、GEJ流出道梗阻且无多峰模式的情况下出现轻微的松弛改变（IRP-4s = 15 mmHg）。1例患者在24小时pH监测中出现病理性酸暴露（PAE）。
HE是一种罕见疾病，HRM对其正确诊断和特征描述至关重要。HE的治疗应使患者症状消失或至少改善，并避免不必要的诊断检查。
