Department of Gastroenterology and Hepatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
Department of Medicine, The Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
Neurogastroenterol Motil. 2017 Sep;29(9). doi: 10.1111/nmo.13099. Epub 2017 May 22.
The current paradigm of measuring esophageal contractile vigor assesses the entirety of a pressure wave using a single measurement, the distal contractile integral (DCI). We hypothesize that an assessment identifying separate phases of the contractile pressure wave before and after the pressure peak may help distinguish abnormalities in patients presenting with chest pain and dysphagia. The aim of the present study was to develop a technique to assess the individual phases and report on the values in healthy controls.
Seventy-one healthy controls were enrolled. High-resolution manometry studies of five intact liquid swallows in both supine and upright positions were analyzed using a customized MATLAB program to divide swallows into a prepeak phase and postpeak phase, and compute the contractile integral of both phases. The contractile integrals were also controlled by duration over each phase.
The composite DCI measurement in healthy controls appears to be weighted toward slightly higher contractile activity during postpeak phase based on postpeak to prepeak ratios in both the supine and upright position (1.50 and 1.49, respectively). The contribution of postpeak phase on the composite DCI was weakened when controlled by time (0.92 and 0.96 in both supine and upright position, respectively).
We developed a novel measurement focused on separating the prepeak and postpeak components of the peristaltic contractile activity during swallowing. Using this technique, it appears that overall contractile activity is higher during postpeak phase and this is related to the longer time component during this phase.
目前评估食管收缩力的范式是使用单一测量值，即远端收缩积分（DCI），来评估压力波的整体情况。我们假设，在压力峰值之前和之后识别收缩压力波的不同阶段的评估方法可能有助于区分出现胸痛和吞咽困难的患者的异常情况。本研究的目的是开发一种评估各个阶段并报告健康对照组值的技术。
纳入 71 名健康对照者。使用定制的 MATLAB 程序分析 5 次完整液体吞咽的仰卧位和直立位高分辨率测压研究，将吞咽分为波峰前和波峰后阶段，并计算两个阶段的收缩积分。收缩积分也通过每个阶段的持续时间进行控制。
健康对照组的综合 DCI 测量值似乎偏向于波峰后阶段的收缩活动稍高，这基于仰卧位和直立位的波峰后与波峰前比值（分别为 1.50 和 1.49）。当通过时间控制时，波峰后阶段对综合 DCI 的贡献减弱（分别为仰卧位和直立位的 0.92 和 0.96）。
我们开发了一种新的测量方法，重点是分离吞咽时蠕动收缩活动的波峰前和波峰后成分。使用该技术，似乎在波峰后阶段的整体收缩活动更高，这与该阶段的较长时间成分有关。
