Division of Gastroenterology and Hepatology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
Division of Gastroenterology and Hepatology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
Clin Gastroenterol Hepatol. 2018 May;16(5):672-680.e1. doi: 10.1016/j.cgh.2017.11.019. Epub 2018 Mar 7.
BACKGROUND & AIMS: Esophageal retention is typically evaluated by timed-barium esophagram in patients treated for achalasia. Esophageal bolus clearance can also be evaluated using high-resolution impedance manometry. We evaluated the associations of conventional and novel high-resolution impedance manometry metrics, esophagram, and patient-reported outcomes (PROs) in achalasia.
We performed a prospective study of 70 patients with achalasia (age, 20-81 y; 30 women) treated by pneumatic dilation or myotomy who underwent follow-up evaluations from April 2013 through December 2015 (median, 12 mo after treatment; range, 3-183 mo). Patients were assessed using timed-barium esophagrams, high-resolution impedance manometry, and PROs, determined from Eckardt scores (the primary outcome) and the brief esophageal dysphagia questionnaire. Barium column height was measured from esophagrams taken 5 minutes after ingestion of barium (200 mL). Impedance-manometry was analyzed for bolus transit (dichotomized) and with a customized MATLAB program (The MathWorks, Inc, Natick, MA) to calculate the esophageal impedance integral (EII) ratio.
Optimal cut points to identify a good PRO (defined as Eckardt score of ≤3) were esophagram barium column height of 3 cm (identified patients with a good PRO with 63% sensitivity and 75% specificity) and an EII ratio of 0.41 (identified patients with a good PRO with 83% sensitivity and 75% specificity). Complete bolus transit identified patients with a good PRO with 28% sensitivity and 75% specificity. Of the 25 patients who met these cut points for both esophagram barium column height and EII ratio, 23 (92%) had a good PRO. Of the 17 patients who met neither cut point, 14 (82%) had a poor PRO (Eckardt score above 3).
In a prospective study of 70 patients with achalasia, we found EII ratio identified patients with good PROs with higher levels of sensitivity (same specificity) than timed-barium esophagram or impedance-manometry bolus transit assessments. The EII ratio should be added to achalasia outcome evaluations that involve high-resolution impedance manometry as an independent measure and to complement timed-barium esophagram.
食管滞留通常通过对接受贲门失弛缓症治疗的患者进行定时钡餐食管造影来评估。食管团块清除也可以使用高分辨率阻抗测压法进行评估。我们评估了传统和新型高分辨率阻抗测压法指标、食管造影和患者报告的结局（PROs）在贲门失弛缓症中的相关性。
我们对 70 例接受气囊扩张或肌切开术治疗的贲门失弛缓症患者（年龄 20-81 岁；30 例女性）进行了前瞻性研究，这些患者于 2013 年 4 月至 2015 年 12 月接受了随访评估（中位时间为治疗后 12 个月；范围为 3-183 个月）。通过定时钡餐食管造影、高分辨率阻抗测压和 PROs（根据 Eckardt 评分确定，主要结局）和简短食管吞咽困难问卷进行评估。在摄入钡剂后 5 分钟（200 mL）进行食管造影时测量钡柱高度。使用定制的 MATLAB 程序（The MathWorks，Inc.，Natick，MA）对阻抗测压进行分析，以计算食管阻抗积分（EII）比值。
识别良好 PRO（定义为 Eckardt 评分≤3）的最佳切点是食管造影钡柱高度 3 cm（识别出具有良好 PRO 的患者，其敏感性为 63%，特异性为 75%）和 EII 比值 0.41（识别出具有良好 PRO 的患者，其敏感性为 83%，特异性为 75%）。完全通过的食管团块可以识别出具有良好 PRO 的患者，其敏感性为 28%，特异性为 75%。在满足食管造影钡柱高度和 EII 比值这两个切点的 25 例患者中，23 例（92%）具有良好的 PRO。在不满足任何一个切点的 17 例患者中，14 例（82%）的 PRO 较差（Eckardt 评分大于 3）。
在对 70 例贲门失弛缓症患者进行的前瞻性研究中，我们发现 EII 比值比定时钡餐食管造影或阻抗测压的食管团块通过评估识别出具有良好 PRO 的患者的敏感性更高（特异性相同）。EII 比值应作为独立指标添加到涉及高分辨率阻抗测压的贲门失弛缓症结局评估中，以补充定时钡餐食管造影。
