食管胃交界部收缩积分（EGJ-CI）可量化手术干预后食管胃交界部屏障功能的变化。
Esophagogastric junction contractile integral (EGJ-CI) quantifies changes in EGJ barrier function with surgical intervention.
作者信息
Wang D, Patel A, Mello M, Shriver A, Gyawali C P
机构信息
Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO, USA.
Gastroenterology Department, The First Hospital of Jilin University, Changchun, Jilin, China.
出版信息
Neurogastroenterol Motil. 2016 May;28(5):639-46. doi: 10.1111/nmo.12757. Epub 2016 Jan 14.
BACKGROUND
Esophagogastric junction contractile integral (EGJ-CI) assesses EGJ barrier function on esophageal high resolution manometry (HRM). We assessed EGJ-CI values in achalasia and gastroesophageal reflux disease (GERD) to determine if postoperative EGJ-CI changes reflected surgical intervention.
METHODS
Twenty-one achalasia patients (42.8 ± 3.2 years, 62% F) with HRM before and after Heller myotomy (HM) and 68 GERD patients (53.9 ± 1.8 years, 66% F) undergoing antireflux surgery (ARS) were compared to 21 healthy controls (27.6 ± 0.6 years, 52% F). Esophagogastric junction contractile integral (mmHg.cm) was calculated using the distal contractile integral measurement across the EGJ, measured above the gastric baseline and corrected for respiration. Pre and postsurgical EGJ-CI and conventional lower esophageal sphincter pressure (LESP) metrics were compared within and between these groups using non-parametric tests. Correlation between EGJ-CI and conventional LESP metrics was assessed.
KEY RESULTS
Baseline EGJ-CI was higher in achalasia compared to GERD (p < 0.001) or controls (p = 0.03). Esophagogastric junction contractile integral declined by 59.2% after HM in achalasia (p = 0.001), and increased by 26.3% after ARS in GERD (p = 0.005). End-expiratory and basal LESP decreased by 74.5% and 64.5% with HM, but increased by only 17.8% and 4.3% with ARS. Differences were noted between Dor vs Toupet fundoplication in achalasia (p = 0.007), and partial vs complete ARS in GERD (p = 0.03). Esophagogastric junction contractile integral correlated modestly with both end-expiratory and basal LESP (Pearson's r of 0.8 for all), but was less robust in GERD (0.7).
CONCLUSIONS & INFERENCES: Esophagogastric junction contractile integral has clinical utility in assessing EGJ barrier function at baseline and after surgical intervention to the EGJ, and could complement conventional EGJ metrics.
背景
食管胃交界部收缩积分（EGJ-CI）用于评估食管高分辨率测压（HRM）时的食管胃交界部屏障功能。我们评估了贲门失弛缓症和胃食管反流病（GERD）患者的EGJ-CI值，以确定术后EGJ-CI的变化是否反映了手术干预。
方法
将21例贲门失弛缓症患者（42.8±3.2岁，62%为女性）在海勒肌切开术（HM）前后进行HRM检查，以及68例接受抗反流手术（ARS）的GERD患者（53.9±1.8岁，66%为女性）与21名健康对照者（27.6±0.6岁，52%为女性）进行比较。食管胃交界部收缩积分（mmHg.cm）通过在食管胃交界部上方测量的远端收缩积分计算得出，以胃基线为参照，并进行呼吸校正。使用非参数检验对这些组内和组间的术前和术后EGJ-CI以及传统的食管下括约肌压力（LESP）指标进行比较。评估EGJ-CI与传统LESP指标之间的相关性。
主要结果
与GERD（p<0.001）或对照组（p=0.03）相比，贲门失弛缓症患者的基线EGJ-CI更高。贲门失弛缓症患者在HM后EGJ-CI下降了59.2%（p=0.001），而GERD患者在ARS后EGJ-CI增加了26.3%（p=0.005）。呼气末和基础LESP在HM后分别下降了74.5%和64.5%，而在ARS后仅分别增加了17.8%和4.3%。贲门失弛缓症患者中，Dor术式与Toupet胃底折叠术之间存在差异（p=0.007），GERD患者中部分抗反流手术与完全抗反流手术之间存在差异（p=0.03）。EGJ-CI与呼气末及基础LESP均呈适度相关（Pearson相关系数均为0.8），但在GERD患者中相关性较弱（0.7）。
结论与推论
食管胃交界部收缩积分在评估基线时以及对食管胃交界部进行手术干预后的食管胃交界部屏障功能方面具有临床应用价值，并且可以补充传统的食管胃交界部指标。
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