Akimoto S, Singhal S, Masuda T, Mittal S K
Creighton University School of Medicine, Omaha, Nebraska.
Norton Thoracic Institute, St. Joseph Hospital and Medical Center, Dignity Health, Phoenix Arizona, USA.
Dis Esophagus. 2017 Jun 1;30(6):1-6. doi: 10.1093/dote/dox048.
We propose a new classification for esophagogastric junction (EGJ) incorporating both physiologic and morphologic characteristics. Additionally, we contrast it with the Chicago v 3.0 EGJ classification. With Institutional Review Board (IRB) approval, prospectively maintained database was queried to identify patients who underwent high-resolution manometry (HRM) and pH-study between October 2011 and October 2015. Patients with prior foregut intervention, pH study on acid suppression, esophageal dysmotility, or lower esophageal sphincter-crural diaphragm separation of >5 cm were excluded. We classified patients into three groups-Type-A: Complete overlap of lower esophageal sphincter-crural diaphragm (single high-pressure zone); Type-B: Double high-pressure zone with pressure inversion point (PIP) at or above lower esophageal sphincter; Type-C: Double high-pressure zone with PIP below lower esophageal sphincter. A total of 214 included patients were divided into Type-A (n = 101), Type-B (n = 32), and Type-C (n = 81). Abdominal lower esophageal sphincter length (AL), lower esophageal sphincter pressure (LESP), and lower esophageal sphincter pressure integral (LESPI) were significantly lower in Type-C than both Type-A and Type-B [AL(cm): 0.2 vs. 2(P < 0.001) vs. 1.6(P <0.001); LESP(mmHg): 20.1 vs. 32.1(P < 0.001) vs. 29.2(P < 0.001); LESPI(mmHg.cm.s): 187 vs. 412(P < 0.001) vs. 343(P < 0.05)] while overall lower esophageal sphincter length(OL) and Integrated Relaxation Pressure (IRP) were significantly lower in Type-C than Type-A [OL(cm): 2.9 vs. 3.6(P < 0.001); IRP(mmHg): 8.2 vs. 9.6(P < 0.05)]. Type-C patients had significantly higher positive pH score (>14.7) than Type-A and Type-B [72% vs. 47% (P < 0.05) vs. 41% (P < 0.001)]. In Type-C morphology, there is both anatomical and physiological deterioration, weakest lower esophageal sphincter function (abdominal length, lower esophageal sphincter pressure, and lower esophageal sphincter pressure integral) and is most likely to be associated with pathological reflux. This proposed classification incorporates both physiological and morphological derangements in a graded fashion.
我们提出了一种新的食管胃交界（EGJ）分类方法，该方法纳入了生理和形态学特征。此外，我们将其与芝加哥v 3.0版EGJ分类进行了对比。经机构审查委员会（IRB）批准，查询前瞻性维护的数据库，以识别2011年10月至2015年10月期间接受高分辨率测压（HRM）和pH研究的患者。排除有先前前肠干预、酸抑制的pH研究、食管动力障碍或食管下括约肌-膈脚分离>5 cm的患者。我们将患者分为三组——A型：食管下括约肌-膈脚完全重叠（单一高压区）；B型：双高压区，压力反转点（PIP）位于食管下括约肌或其上方；C型：双高压区，PIP位于食管下括约肌下方。总共214例纳入患者被分为A型（n = 101）、B型（n = 32）和C型（n = 81）。C型患者的腹段食管下括约肌长度（AL）、食管下括约肌压力（LESP）和食管下括约肌压力积分（LESPI）显著低于A型和B型患者[AL（cm）：0.2 vs. 2（P < 0.001）vs. 1.6（P <0.001）；LESP（mmHg）：20.1 vs. 32.1（P < 0.001）vs. 29.2（P < 0.001）；LESPI（mmHg.cm.s）：187 vs. 412（P < 0.001）vs. 343（P < 0.05）]，而C型患者的总体食管下括约肌长度（OL）和综合松弛压（IRP）显著低于A型患者[OL（cm）：2.9 vs. 3.6（P < 0.001）；IRP（mmHg）：8.2 vs. 9.6（P < 0.05）]。C型患者的阳性pH评分（>14.
