Triantafyllou Tania, Theodoropoulos Charalampos, Mantides Apostolos, Chrysikos Demosthenis, Smparounis Spyridon, Filis Konstantinos, Zografos Georgios, Theodorou Dimitrios
Foregut Surgery Department, 1st Propaedeutic Surgical Clinic, Hippocration General Hospital Athens (Tania Triantafyllou, Charalampos Theodoropoulos, Demosthenis Chrysikos, Spyridon Smparounis, Konstantinos Filis, Georgios Zografos, Dimitrios Theodorou).
Private Practice (Apostolos Mantides), Athens, Greece.
Ann Gastroenterol. 2018 Jul-Aug;31(4):456-461. doi: 10.20524/aog.2018.0270. Epub 2018 May 3.
The use of high-resolution manometry (HRM) in achalasia patients has revealed abnormal findings concerning upper esophageal sphincter (UES) function. The introduction of the UES contractile integral (UES-CI), as with the distal contractile integral (DCI), may complement the interpretation of the manometric study of achalasia subtypes, defined by the Chicago Classification v3.0.
Patients were classified into achalasia subtypes based on HRM. UES length (cm), UES resting pressure (mmHg), and UES residual pressure (mmHg) were recorded. UES-CI (mmHg·sec·cm) was calculated in a manner similar to that used for the DCI measurement at rest (landmark CI), corrected for respiration, and its relation to achalasia subtypes was evaluated.
Twenty-four achalasia patients with mean age 55.29 years were included. Of these, 16.6% (n=4) were diagnosed with achalasia type I, 58.3% (n=14) with type II, and 25% (n=6) with type III. The landmark UES-CI, mean UES-CI, UES-CI corrected for respiration, and UES resting pressure were found to be significantly higher among patients with achalasia type II compared to the other types (1768.9 vs. 677.1, P=0.03; 1827.1 vs. 3555.1, P=0.036; 174.2 vs. 72.8, P=0.027; and 108.1 vs. 55.8, P=0.009, respectively).
We introduce the CI index as a tool for the manometric evaluation of the UES in achalasia. UES resting pressure, landmark UES-CI and mean UES-CI were significantly higher in achalasia patients with panesophageal pressurization compared to types I and III. This finding may reflect a protective reaction against the risk of aspiration in this group, but further studying and clinical correlation is required.
在贲门失弛缓症患者中使用高分辨率测压法（HRM）已揭示出有关食管上括约肌（UES）功能的异常发现。与远端收缩积分（DCI）一样，UES收缩积分（UES-CI）的引入可能会补充对由芝加哥分类v3.0定义的贲门失弛缓症亚型的测压研究的解释。
根据HRM将患者分为贲门失弛缓症亚型。记录UES长度（厘米）、UES静息压（毫米汞柱）和UES残余压（毫米汞柱）。以与静息时DCI测量（地标CI）类似的方式计算UES-CI（毫米汞柱·秒·厘米），校正呼吸因素，并评估其与贲门失弛缓症亚型的关系。
纳入了24例平均年龄为55.29岁的贲门失弛缓症患者。其中，16.6%（n = 4）被诊断为I型贲门失弛缓症，58.3%（n = 14）为II型，25%（n = 6）为III型。与其他类型相比，II型贲门失弛缓症患者的地标UES-CI、平均UES-CI、校正呼吸后的UES-CI和UES静息压显著更高（分别为1768.9对677.1，P = 0.03；1827.1对3555.1，P = 0.036；174.2对72.8，P = 0.027；以及108.1对55.8，P = 0.009）。
我们引入CI指数作为贲门失弛缓症中UES测压评估的工具。与I型和III型相比，全食管加压的贲门失弛缓症患者的UES静息压、地标UES-CI和平均UES-CI显著更高。这一发现可能反映了该组对误吸风险的一种保护反应，但需要进一步研究和临床相关性分析。
