Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Good Liver Clinic, Taipei, Taiwan.
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
J Formos Med Assoc. 2019 Nov;118(11):1528-1536. doi: 10.1016/j.jfma.2018.12.019. Epub 2019 Jan 8.
Esophageal motility disorders are the major cause of non-obstructive dysphagia (NOD), but may be underdiagnosed. In this high-resolution impedance manometry (HRIM)-based study, we aimed to clarify the etiologies and clinical characteristics of patients presenting with NOD in a Taiwanese population.
From October 2014 to July 2017, consecutive patients with the chief complaint of dysphagia were prospectively enrolled in the study at a tertiary medical center. All subjects underwent a comprehensive diagnostic work-up, which included validated symptom questionnaires, esophagogastroduodenoscopy, timed barium esophagogram, and HRIM. Those with obstructive esophageal lesions were excluded. Esophageal motility disorders were diagnosed using the updated Chicago Classification v3.0. We categorized all patients based on the HRIM results, and compared the clinical characteristics and parameters between groups.
A total of 120 patients (55 men; mean age [range], 52 [13-87] years) were analyzed. Achalasia was the most common diagnosis by HRIM (n = 66, 55%), followed by ineffective esophageal motility (n = 15, 12.5%), and absent contractility (n = 6, 5%). Patients with achalasia experienced increased vomiting (62.1% vs. 31.5%, p = 0.001), significant weight loss (22.7% vs. 7.4%, p = 0.025), delayed esophageal emptying (90.9% vs. 12.9%, p < 0.001), and abnormal bolus transit (100% vs. 25.9%, p < 0.001) compared with non-achalasia patients.
Based on HRIM and the updated Chicago Classification, achalasia was the most common diagnosis of NOD in a Taiwanese population. HRIM allows for a more detailed assessment and may assist in the tailoring of further treatment plans.
食管运动障碍是引起非梗阻性吞咽困难（NOD）的主要原因，但可能存在漏诊。在这项基于高分辨率阻抗测压（HRIM）的研究中，我们旨在阐明台湾人群中出现 NOD 的患者的病因和临床特征。
从 2014 年 10 月至 2017 年 7 月，连续在一家三级医疗中心以吞咽困难为主诉的患者前瞻性纳入本研究。所有患者均接受全面的诊断性检查，包括经过验证的症状问卷、食管胃十二指肠镜检查、时间分辨钡餐食管造影和 HRIM。排除有食管梗阻性病变的患者。采用更新的芝加哥分类 v3.0 诊断食管运动障碍。我们根据 HRIM 结果对所有患者进行分类，并比较组间的临床特征和参数。
共分析了 120 例患者（55 例男性；平均年龄[范围]，52[13-87]岁）。HRIM 最常见的诊断为贲门失弛缓症（n=66，55%），其次为无效食管动力（n=15，12.5%）和无收缩力（n=6，5%）。贲门失弛缓症患者呕吐发生率增加（62.1%比 31.5%，p=0.001），显著体重减轻（22.7%比 7.4%，p=0.025），食管排空延迟（90.9%比 12.9%，p<0.001），和异常食团转运（100%比 25.9%，p<0.001）。
根据 HRIM 和更新的芝加哥分类，贲门失弛缓症是台湾人群中 NOD 最常见的诊断。HRIM 可进行更详细的评估，并有助于制定进一步的治疗计划。
