Monrroy H, Cisternas D, Bilder C, Ditaranto A, Remes-Troche J, Meixueiro A, Zavala M A, Serra J, Marín I, Ruiz de León A, Pérez de la Serna J, Hani A, Leguizamo A, Abrahao L, Coello R, Valdovinos M A
Department of Gastroenterology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
Universidad del Desarrollo, School of Medicine, Clínica Alemana de Santiago, Santiago, Chile.
Am J Gastroenterol. 2017 Apr;112(4):606-612. doi: 10.1038/ajg.2017.10. Epub 2017 Jan 31.
High-resolution manometry (HRM) is the preferred method for the evaluation of motility disorders. Recently, an update of the diagnostic criteria (Chicago 3.0) has been published. The aim of this study was to compare the performance criteria of Chicago version 2.0 (CC2.0) vs. 3.0 (CC3.0) in a cohort of healthy volunteers and symptomatic patients.
HRM studies of asymptomatic and symptomatic individuals from several centers of Spain and Latin America were analyzed using both CC2.0 and CC3.0. The final diagnosis was grouped into hierarchical categories: obstruction (achalasia and gastro-esophageal junction obstruction), major disorders (distal esophageal spasm, absent peristalsis, and jackhammer), minor disorders (failed frequent peristalsis, weak peristalsis with small or large defects, ineffective esophageal motility, fragmented peristalsis, rapid contractile with normal latency and hypertensive peristalsis) and normal. The results were compared using McNemar's and Kappa tests.
HRM was analyzed in 107 healthy volunteers (53.3% female; 18-69 years) and 400 symptomatic patients (58.5% female; 18-90 years). In healthy volunteers, using CC2.0 and CC3.0, obstructive disorders were diagnosed in 7.5% and 5.6%, respectively, major disorders in 1% and 2.8%, respectively, minor disorders in 25.2% and 15%, respectively, and normal in 66.4% and 76.6%, respectively. In symptomatic individuals, using CC2.0 and CC3.0, obstructive disorders were diagnosed in 11% and 11.3%, respectively, major disorders in 14% and 14%, respectively, minor disorders in 33.3% and 24.5%, respectively, and normal in 41.8% and 50.3%, respectively. In both groups of individuals, only an increase in normal and a decrease in minor findings using CC3.0 were statistically significant using McNemar's test.
CC3.0 increases the number of normal studies when compared with CC2.0, essentially at the expense of fewer minor disorders, with no significant differences in major or obstructive disorders. As the relevance of minor disorders is questionable, our data suggest that CC3.0 increases the relevance of abnormal results.
高分辨率测压法（HRM）是评估动力障碍的首选方法。最近，诊断标准（芝加哥3.0版）已发布。本研究的目的是比较芝加哥2.0版（CC2.0）与3.0版（CC3.0）在一组健康志愿者和有症状患者中的性能标准。
使用CC2.0和CC3.0对来自西班牙和拉丁美洲多个中心的无症状和有症状个体的HRM研究进行分析。最终诊断分为分层类别：梗阻（贲门失弛缓症和胃食管交界梗阻）、主要障碍（食管远端痉挛、蠕动缺失和强力收缩）、次要障碍（频发蠕动失败、伴有小或大缺陷的弱蠕动、食管动力无效、蠕动破碎、潜伏期正常的快速收缩和高血压蠕动）和正常。使用McNemar检验和Kappa检验比较结果。
对107名健康志愿者（女性占53.3%；18 - 69岁）和400名有症状患者（女性占58.5%；18 - 90岁）进行了HRM分析。在健康志愿者中，使用CC2.0和CC3.0时，梗阻性障碍的诊断率分别为7.5%和5.6%，主要障碍的诊断率分别为1%和2.8%，次要障碍的诊断率分别为25.2%和15%，正常的诊断率分别为66.4%和76.6%。在有症状个体中，使用CC2.0和CC3.0时，梗阻性障碍的诊断率分别为11%和11.3%，主要障碍的诊断率分别为14%和14%，次要障碍的诊断率分别为33.3%和24.5%，正常的诊断率分别为41.8%和50.3%。在两组个体中，使用McNemar检验，只有使用CC3.0时正常结果增加和次要发现减少具有统计学意义。
与CC2.0相比，CC3.0增加了正常研究的数量，主要是以减少次要障碍为代价，在主要或梗阻性障碍方面没有显著差异。由于次要障碍的相关性存在疑问，我们的数据表明CC3.0增加了异常结果的相关性。
