Rommel Nathalie, Rayyan Maissa, Scheerens Charlotte, Omari Taher
Neurogastroenterology and Motility, Gastroenterology, University Hospitals Leuven, Leuven, Belgium.
Experimental Otorhinolaryngology, Department of Neurosciences, Deglutology, University of Leuven, Leuven, Belgium.
Front Pediatr. 2017 Jun 21;5:137. doi: 10.3389/fped.2017.00137. eCollection 2017.
Infants and children with esophageal atresia commonly present with swallowing dysfunction or dysphagia. Dysphagia can lead to a range of significant consequences such as aspiration pneumonia, malnutrition, dehydration, and food impaction. To improve oral intake, the clinical diagnosis of dysphagia in patients with esophageal atresia should focus on both the pharynx and the esophagus. To characterize the complex interactions of bolus flow and motor function between mouth, pharynx, and esophagus, a detailed understanding of normal and abnormal deglutition is required through the use of adequate and objective assessment techniques. As clinical symptoms do not correlate well with conventional assessment methods of motor function such as radiology or manometry but do correlate with bolus flow, the current state-of-the-art diagnosis involves high-resolution manometry combined with impedance measurements to characterize the interplay between esophageal motor function and bolus clearance. Using a novel pressure flow analysis (PFA) method as an integrated analysis method of manometric and impedance measurements, differentiation of patients with impaired esophago-gastric junction relaxation from patients with bolus outflow disorders is clinically relevant. In this, pressure flow matrix categorizing the quantitative PFA measures may be used to make rational therapeutic decisions in patients with esophageal atresia. Through more advanced diagnostics, improved understanding of pathophysiology may improve our patient care by directly targeting the failed biomechanics of both the pharynx and the esophagus.
患有食管闭锁的婴幼儿通常会出现吞咽功能障碍或吞咽困难。吞咽困难会导致一系列严重后果，如吸入性肺炎、营养不良、脱水和食物嵌塞。为了改善经口摄入量，食管闭锁患者吞咽困难的临床诊断应同时关注咽部和食管。为了描述口腔、咽部和食管之间团块流动与运动功能的复杂相互作用，需要通过使用适当且客观的评估技术来详细了解正常和异常吞咽情况。由于临床症状与放射学或测压法等传统运动功能评估方法相关性不佳，但与团块流动相关，目前的先进诊断方法包括高分辨率测压结合阻抗测量，以描述食管运动功能与团块清除之间的相互作用。使用一种新颖的压力流分析（PFA）方法作为测压和阻抗测量的综合分析方法，区分食管胃交界处松弛受损患者与团块流出障碍患者具有临床相关性。在此过程中，对定量PFA测量进行分类的压力流矩阵可用于为食管闭锁患者做出合理的治疗决策。通过更先进的诊断方法，对病理生理学的更好理解可能通过直接针对咽部和食管失败的生物力学来改善我们对患者的护理。
