Ashraf Hafiz Hamad, Palmer Joanne, Dalton Harry Richard, Waters Carolyn, Luff Thomas, Strugnell Madeline, Murray Iain Alexander
Hafiz Hamad Ashraf, Harry Richard Dalton, Carolyn Waters, Iain Alexander Murray, Departments of Gastroenterology, Royal Cornwall Hospital NHS Trust, Truro TR1 3LJ, United Kingdom.
World J Gastroenterol. 2017 Feb 14;23(6):1038-1043. doi: 10.3748/wjg.v23.i6.1038.
To determine if patients can localise dysphagia level determined endoscopically or radiologically and association of gender, age, level and pathology.
Retrospective review of consecutive patients presenting to dysphagia hotline between March 2004 and March 2015 was carried out. Demographics, clinical history and investigation findings were recorded including patient perception of obstruction level (pharyngeal, mid sternal or low sternal) was documented and the actual level of obstruction found on endoscopic or radiological examination (if any) was noted. All patients with evidence of obstruction including oesophageal carcinoma, peptic stricture, Schatzki ring, oesophageal pouch and cricopharyngeal hypertrophy were included in the study who had given a perceived level of dysphagia. The upper GI endoscopy reports (barium study where upper GI endoscopy was not performed) were reviewed to confirm the distance of obstructing lesion from central incisors. A previously described anatomical classification of oesophagus was used to define the level of obstruction to be upper, middle or lower oesophagus and this was compared with patient perceived level.
Three thousand six hundred and sixty-eight patients were included, 42.0% of who were female, mean age 70.7 ± 12.8 years old. Of those with obstructing lesions, 726 gave a perceived level of dysphagia: 37.2% had oesophageal cancer, 36.0% peptic stricture, 13.1% pharyngeal pouches, 10.3% Schatzki rings and 3.3% achalasia. Twenty-seven point five percent of patients reported pharyngeal level (upper) dysphagia, 36.9% mid sternal dysphagia and 25.9% lower sternal dysphagia (9.5% reported multiple levels). The level of obstructing lesion seen on diagnostic testing was upper (17.2%), mid (19.4%) or lower (62.9%) or combined (0.3%). When patients localised their level of dysphagia to a single level, the kappa statistic was 0.245 ( < 0.001), indicating fair agreement. 48% of patients reporting a single level of dysphagia were accurate in localising the obstructing pathology. With respect to pathology, patients with pharyngeal pouches were most accurate localising their level of dysphagia ( < 0.001). With respect to level of dysphagia, those with pharyngeal level lesions were best able to identify the level of dysphagia accurately ( < 0.001). No association ( > 0.05) was found between gender, patient age or clinical symptoms with their ability to detect the level of dysphagia.
Patient perceived level of dysphagia is unreliable in determining actual level of obstructing pathology and should not be used to tailor investigations.
确定患者能否定位通过内镜或放射学检查确定的吞咽困难水平，以及性别、年龄、水平和病理之间的关联。
对2004年3月至2015年3月期间拨打吞咽困难热线的连续患者进行回顾性研究。记录人口统计学、临床病史和检查结果，包括患者对梗阻水平（咽部、胸骨中段或胸骨下段）的感知情况，并记录在内镜或放射学检查（如有）中发现的实际梗阻水平。所有有梗阻证据的患者，包括食管癌、消化性狭窄、沙茨基环、食管憩室和环咽肌肥大患者，只要给出了吞咽困难的感知水平，均纳入本研究。回顾上消化道内镜检查报告（未进行上消化道内镜检查时的钡餐检查），以确认梗阻病变距中切牙的距离。采用先前描述的食管解剖分类来定义梗阻水平为食管上段、中段或下段，并将其与患者感知水平进行比较。
共纳入3668例患者，其中42.0%为女性，平均年龄70.7±12.8岁。在有梗阻病变的患者中，726例给出了吞咽困难的感知水平：37.2%患有食管癌，36.0%患有消化性狭窄，13.1%患有咽憩室，10.3%患有沙茨基环，3.3%患有贲门失弛缓症。27.5%的患者报告咽部水平（上段）吞咽困难，36.9%报告胸骨中段吞咽困难，25.9%报告胸骨下段吞咽困难（9.5%报告多个水平）。诊断检查中发现的梗阻病变水平为上段（17.2%）、中段（19.4%）或下段（62.9%）或合并（0.3%）。当患者将吞咽困难水平定位到单一水平时，kappa统计量为0.245（<0.001），表明一致性一般。报告单一水平吞咽困难的患者中有48%能够准确定位梗阻病理。就病理而言，患有咽憩室的患者在定位吞咽困难水平方面最准确（<0.001）。就吞咽困难水平而言，患有咽部水平病变的患者最能准确识别吞咽困难水平（<0.001）。在性别、患者年龄或临床症状与他们检测吞咽困难水平的能力之间未发现关联（>0.05）。
患者感知的吞咽困难水平在确定实际梗阻病理水平方面不可靠，不应以此来指导检查。
