Digestive Disease Unit, Campus Bio Medico University, Rome, Italy.
J Clin Gastroenterol. 2018 Aug;52(7):607-613. doi: 10.1097/MCG.0000000000000903.
The present study was aimed at evaluating, in dysphagic patients, the role of high-resolution manometry (HRM) findings, presence of gastroesophageal reflux disease (GERD), and proton-pump inhibitor (PPI) therapy on dysphagia perception.
A relevant proportion of patients with nonobstructive dysphagia present normal esophageal HRM findings. Patients with GERD often complain of dysphagia and factors, such as hypersensitivity, might be involved in its occurrence.
In total, 37 nonerosive reflux disease (NERD) patients with only dysphagia (group 1) and 52 patients with both dysphagia and typical GERD symptoms (group 2) were evaluated with symptom scores, HRM combined with impedance and 24 hours impedance-pH monitoring. In total, 44 NERD patients, not presenting dysphagia, underwent the same protocol. A total of 22/37 group 1 patients [11 with pathologic acid exposure time (AET)] were treated with esomeprazole 40 mg oid for 4 weeks and were reassessed during the last week of therapy.
A total of 15/37 group 1 patients (40%), 27/52 group 2 patients (52%), and 19/44 (43%) NERD patients presented pathologic AET [P=not significant (NS)]. Group 1 patients with a pathologic AET showed a significantly lower mean distal contractile integral (DCI) and a significant correlation (ρ=-0.71) between individual DCI and total bolus transit time values. During PPI therapy, in group 1 patients with pathologic AET, the mean dysphagia score value decreased significantly [7.5 (range, 3 to 9) before, 4 (range, 2 to 6) during PPI; P<0.01)] and mean DCI value increased significantly.
In total, 40% of dysphagic patients show a pathologic AET and reduced peristaltic vigor. In these patients, an adequate PPI therapy significantly decreases dysphagia frequency and severity and improves the esophageal peristaltic force.
本研究旨在评估在吞咽困难患者中，高分辨率测压（HRM）结果、胃食管反流病（GERD）的存在以及质子泵抑制剂（PPI）治疗对吞咽困难感知的作用。
相当一部分非梗阻性吞咽困难患者的食管 HRM 结果正常。GERD 患者常主诉吞咽困难，而敏感性等因素可能与其发生有关。
共有 37 名仅有吞咽困难的非糜烂性反流病（NERD）患者（组 1）和 52 名既有吞咽困难又有典型 GERD 症状的患者（组 2）接受了症状评分、HRM 联合阻抗和 24 小时阻抗-pH 监测。共有 44 名无吞咽困难的 NERD 患者接受了相同的方案。共有 22/37 组 1 患者（11 名酸暴露时间异常）接受了艾司奥美拉唑 40mg 一日一次治疗 4 周，并在治疗的最后一周进行了重新评估。
共有 15/37 组 1 患者（40%）、27/52 组 2 患者（52%）和 19/44（43%）NERD 患者的酸暴露时间异常[无显著差异（NS）]。酸暴露时间异常的组 1 患者的平均远端收缩积分（DCI）明显较低，且个体 DCI 值与总食团通过时间值之间存在显著相关性（ρ=-0.71）。在 PPI 治疗期间，酸暴露时间异常的组 1 患者的平均吞咽困难评分值显著降低[治疗前 7.5（范围 3 至 9），治疗期间 4（范围 2 至 6）；P<0.01]，且平均 DCI 值显著升高。
吞咽困难患者中共有 40%存在酸暴露时间异常和蠕动收缩力减弱。在这些患者中，适当的 PPI 治疗可显著降低吞咽困难的频率和严重程度，并改善食管蠕动功能。
