Woodland Philip, Gabieta-Sonmez Shirley, Arguero Julieta, Ooi Joanne, Nakagawa Kenichiro, Glasinovic Esteban, Yazaki Etsuro, Sifrim Daniel
Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
J Neurogastroenterol Motil. 2018 Jul 30;24(3):410-414. doi: 10.5056/jnm18038.
BACKGROUND/AIMS: Single swallow integrated relaxation pressure (IRP) on high-resolution manometry (HRM) does not always accurately predict esophagogastric outflow obstruction on timed barium esophagogram (TBE). Furthermore, neither single swallow IRP or TBE is reliable in predicting symptoms, particularly after treatment with dilatation or myotomy. A 200 mL rapid drink challenge (RDC) has been proposed as an adjunctive test during HRM. This serves as a "stress-test" to the esophagogastric junction, and may yield clinically useful parameters. We aim to assess HRM parameters during RDC, and their ability to predict outflow obstruction on TBE in patients with dysphagia, and to correlate with symptoms in patients' achalasia.
Thirty patients with dysphagia were recruited. All underwent standard single swallow HRM analysis, 200 mL RDC, then TBE. RDC parameters, including esophagogastric pressure gradient, IRP, and RDC duration were evaluated. Multiple regression analysis was performed to assess the best predictive parameter for obstruction on TBE. A further 21 patients with achalasia were evaluated with Eckhardt score, single swallow HRM, RDC, and TBE. Parameter correlation with Eckhardt score was evaluated.
Mean IRP during RDC was the best HRM parameter at predicting outflow obstruction on TBE. This performed much better in untreated patients (sensitivity 100% and specificity 85.5%) than in previously treated patients (sensitivity 50% and specificity 66%). In patients with achalasia, mean IRP during RDC was the only parameter that correlated with symptom score.
Mean IRP during RDC appears to be a clinically useful "stress test" to the esophagogastric junction during HRM.
背景/目的：高分辨率测压法（HRM）中单次吞咽综合松弛压（IRP）并不总是能准确预测定时食管钡餐造影（TBE）上的食管胃流出道梗阻。此外，单次吞咽IRP或TBE在预测症状方面都不可靠，尤其是在扩张或肌切开术治疗后。200毫升快速饮水试验（RDC）已被提议作为HRM期间的辅助检查。这对食管胃交界处起到“压力测试”的作用，并可能产生临床上有用的参数。我们旨在评估RDC期间的HRM参数，及其预测吞咽困难患者TBE上流出道梗阻的能力，并与贲门失弛缓症患者的症状相关联。
招募了30名吞咽困难患者。所有人都接受了标准的单次吞咽HRM分析、200毫升RDC，然后是TBE。评估了RDC参数，包括食管胃压力梯度、IRP和RDC持续时间。进行多元回归分析以评估TBE上梗阻的最佳预测参数。另外21名贲门失弛缓症患者通过埃克哈特评分、单次吞咽HRM、RDC和TBE进行评估。评估参数与埃克哈特评分的相关性。
RDC期间的平均IRP是预测TBE上流出道梗阻的最佳HRM参数。这在未治疗的患者中（敏感性100%，特异性85.5%）比在先前治疗过的患者中（敏感性50%，特异性66%）表现要好得多。在贲门失弛缓症患者中，RDC期间的平均IRP是唯一与症状评分相关的参数。
RDC期间的平均IRP似乎是HRM期间对食管胃交界处临床上有用的“压力测试”。
