Stanford Multidimensional Program for Innovation and Research in the Esophagus (S-MPIRE), Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 300 Pasteur Drive, Alway Building, Room M211, Stanford, CA, 94305-5187, USA.
Dig Dis Sci. 2018 Dec;63(12):3417-3424. doi: 10.1007/s10620-018-5175-4. Epub 2018 Jun 26.
BACKGROUND: Gastric and esophageal dysmotility syndromes are some of the most common motility diagnoses, but little is known about their interrelationship. AIMS: The aim of our study was to determine if a correlation exists between gastric and esophageal dysmotility syndromes. METHODS: We reviewed the records of all patients who underwent both solid gastric emptying scintigraphy (GES) and high-resolution esophageal manometry (HRM) within a 2 year period, with both done between August 2012 and August 2017. All GESs were classified as either rapid, normal, or delayed. All HRMs were classified according to the Chicago Classification 3.0. Correlations were assessed using Fisher's exact test and multiple logistic regression. RESULTS: In total, 482 patients met inclusion criteria. Of patients with a normal, delayed, and rapid GES, 53.1, 64.5, and 77.3% had an abnormal HRM, respectively (p < 0.05 vs. normal GES). Likewise, patients with an abnormal HRM were more likely to have an abnormal GES (54.9 vs. 41.8%, p = 0.005). Multiple logistic regression showed abnormal GES [odds ratio (OR) 2.14], age (OR 1.013), scleroderma (OR 6.29), and dysphagia (OR 2.63) were independent predictors of an abnormal HRM. Likewise, an abnormal HRM (OR 2.11), diabetes (OR 1.85), heart or lung transplantation (OR 2.61), and autonomic dysfunction (OR 2.37) were independent predictors of an abnormal GES. CONCLUSIONS: The correlation between an abnormal GES and HRM argues for common pathogenic mechanisms of these motility disorders, and possibly common future treatment options. Clinicians should have a high index of suspicion for another motility disorder if one is present.
背景:胃和食管动力障碍综合征是一些最常见的动力诊断,但对它们之间的相互关系知之甚少。
目的:我们的研究目的是确定胃和食管动力障碍综合征之间是否存在相关性。
方法:我们回顾了 2012 年 8 月至 2017 年 8 月期间所有同时进行固体胃排空闪烁显像(GES)和高分辨率食管测压(HRM)检查的患者的病历记录,所有 GES 均分为快速、正常和延迟。所有 HRM 均根据芝加哥分类 3.0 进行分类。采用 Fisher 确切检验和多因素逻辑回归评估相关性。
结果:共有 482 例患者符合纳入标准。正常、延迟和快速 GES 的患者中,分别有 53.1%、64.5%和 77.3%的 HRM 异常(p<0.05 与正常 GES 相比)。同样,HRM 异常的患者更有可能出现 GES 异常(54.9%比 41.8%,p=0.005)。多因素逻辑回归显示,GES 异常[比值比(OR)2.14]、年龄(OR 1.013)、硬皮病(OR 6.29)和吞咽困难(OR 2.63)是 HRM 异常的独立预测因素。同样,HRM 异常(OR 2.11)、糖尿病(OR 1.85)、心脏或肺移植(OR 2.61)和自主神经功能障碍(OR 2.37)是 GES 异常的独立预测因素。
结论:GES 和 HRM 异常之间的相关性表明这些动力障碍存在共同的发病机制,并且可能有共同的未来治疗选择。如果存在一种动力障碍,临床医生应该对另一种动力障碍有很高的怀疑指数。
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