Northwestern University, Feinberg School of Medicine, Department of Medicine, 676 St Clair Street, 14th floor, Chicago, Illinois 60611-2951, USA.
Academic Medical Centre, Department of Gastroenterology and Hepatology, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
Nat Rev Gastroenterol Hepatol. 2017 Nov;14(11):677-688. doi: 10.1038/nrgastro.2017.132. Epub 2017 Sep 27.
High-resolution manometry (HRM) and new analysis algorithms, summarized in the Chicago Classification, have led to a restructured classification of oesophageal motility disorders. This advance has led to increased detection of clinically relevant disorders, in particular achalasia. It has become apparent that the cardinal feature of achalasia - impaired lower oesophageal sphincter (LES) relaxation - can occur in several disease phenotypes: without peristalsis (type I), with pan-oesophageal pressurization (type II), with premature (spastic) distal oesophageal contractions (type III), or with preserved peristalsis (outlet obstruction). Furthermore, no manometric pattern is perfectly sensitive or specific for achalasia caused by a myenteric plexopathy, and there is no biomarker for this pathology. Consequently, physiological testing reveals other syndromes not meeting achalasia criteria that also benefit from therapies formerly reserved for achalasia. These findings have become particularly relevant with the development of a minimally invasive technique for performing a long oesophageal myotomy, the per-oral endoscopic myotomy (POEM). Optimal management is to render treatment in a phenotype-specific manner; that is, POEM calibrated to patient-specific physiology for spastic achalasia and the spastic disorders, and more conservative strategies such as pneumatic dilation for the disorders limited to the LES. This Consensus Statement examines the effect of HRM on our understanding of oesophageal motility disorders, with a focus on the diagnosis, epidemiology and management of achalasia and achalasia-like syndromes.
高分辨率测压（HRM）和新的分析算法，总结在芝加哥分类中，导致了食管动力障碍的分类结构的改变。这一进展导致了更多临床相关疾病的发现，特别是贲门失弛缓症。很明显，贲门失弛缓症的主要特征 - 食管下括约肌（LES）松弛受损 - 可以在几种疾病表型中出现：无蠕动（I 型）、全食管高压（II 型）、过早（痉挛性）远端食管收缩（III 型）或蠕动保留（出口梗阻）。此外，没有一种测压模式对由肌间神经丛病变引起的贲门失弛缓症具有完美的敏感性或特异性，也没有这种病理学的生物标志物。因此，生理测试揭示了其他不符合贲门失弛缓症标准的综合征，这些综合征也受益于以前为贲门失弛缓症保留的治疗方法。随着一种微创技术 - 经口内镜肌切开术（POEM）的发展，这些发现变得尤为重要。最佳管理是针对特定表型进行治疗；也就是说，根据患者特定的生理学情况对痉挛性贲门失弛缓症和痉挛性疾病进行 POEM 校准，以及对仅局限于 LES 的疾病进行更保守的策略，如气动扩张。本共识声明考察了 HRM 对我们对食管动力障碍理解的影响，重点是贲门失弛缓症和贲门失弛缓症样综合征的诊断、流行病学和管理。
