Division of Gastroenterology and Hepatology, Department of Medicine, Westchester Medical Center, New York Medical College, 40 Sunshine Cottage Road, Skyline 2N-D08, Valhalla, NY, 10595, USA.
Division of Digestive and Liver Diseases, Department of Medicine, Stony Brook School of Medicine, 101 Nicolls Road, Stony Brook, NY, 11794, USA.
Dig Dis Sci. 2019 Mar;64(3):811-814. doi: 10.1007/s10620-018-5384-x. Epub 2018 Dec 10.
Ineffective esophageal motility (IEM) is defined as a distal contractile integral < 450 mmHg/s/cm in at least 50% of ten liquid swallows on high-resolution esophageal manometry (HREM). Whether this latest definition correlates with degree of symptoms has not been studied.
Patients presenting for HREM prospectively rated their symptoms using the Eckardt score. Topography plots were retrospectively reviewed and classified according to the latest Chicago Classification. Patients with non-obstructive dysphagia and an Eckardt score of at least 1 were included. Patients with major motility disorders were excluded. Scores between patients with IEM (group A) and patients with normal classification (group B) were compared using two-tailed t-tests. Spearman's correlation coefficient was calculated to determine correlation between symptoms and percent bolus clearance.
A total of 241 patients were screened; 33 patients met criteria for group A and 44 patients for group B. There was no difference between the two groups in mean symptom severity for dysphagia (1.63 vs. 1.61, P = 0.89), chest pain (0.67 vs. 0.75, P = 0.64), regurgitation (1.06 vs. 0.85, P = 0.32), or weight loss (0.85 vs. 0.49, P = 0.11). The percent bolus clearance was significantly lower in group A (46.5% vs. 76.7%, P > 0.01). There was a moderate inverse correlation between dysphagia and percent bolus clearance (R = - 0.37) in group A, but none in group B (R = 0.09).
The classification of IEM did not discriminate from normal studies for symptom severity in our cohort. However, patients with IEM did have an inverse correlation between dysphagia score and bolus clearance, but those without IEM did not. Adding impedance information to the motor pattern classification should be considered in the symptom assessment in minor motility disorders.
无效食管动力（IEM）定义为在至少 10 次液体吞咽中的至少 50%的高分辨率食管测压（HREM）中远端收缩积分<450mmHg/s/cm。最新的定义是否与症状的严重程度相关尚未研究。
前瞻性呈现 HREM 的患者使用 Eckardt 评分评估他们的症状。回顾性地审查拓扑图，并根据最新的芝加哥分类进行分类。纳入有非阻塞性吞咽困难且 Eckardt 评分至少为 1 的患者。排除有主要运动障碍的患者。使用双尾 t 检验比较 IEM 患者（A 组）和正常分类患者（B 组）之间的评分。计算 Spearman 相关系数以确定症状与食团清除百分比之间的相关性。
共筛选出 241 例患者；33 例患者符合 A 组标准，44 例患者符合 B 组标准。两组间吞咽困难（1.63 对 1.61，P=0.89）、胸痛（0.67 对 0.75，P=0.64）、反流（1.06 对 0.85，P=0.32）和体重减轻（0.85 对 0.49，P=0.11）的平均症状严重程度无差异。A 组的食团清除百分比明显较低（46.5%对 76.7%，P>0.01）。在 A 组中，吞咽困难与食团清除百分比之间存在中度负相关（R=-0.37），而在 B 组中则没有（R=0.09）。
在我们的队列中，IEM 的分类不能区分症状的严重程度与正常研究。然而，IEM 患者的吞咽困难评分与食团清除率之间存在负相关，但无 IEM 患者则没有。在轻微运动障碍的症状评估中，应考虑将阻抗信息添加到运动模式分类中。
