Division of Gastroenterology, Washington University School of Medicine, Saint Louis, MO.
J Clin Gastroenterol. 2020 Jan;54(1):22-27. doi: 10.1097/MCG.0000000000001205.
High-resolution manometry (HRM) allows characterization of esophagogastric junction (EGJ) morphology and identification of hiatus hernia using novel software tools.
The main purpose of this study was to determine the impact of HRM-based EGJ and lower esophageal sphincter (LES) metrics in predicting abnormal reflux burden.
Total, upright, and supine acid exposure times (AETs) were extracted from ambulatory reflux monitoring performed off therapy in 482 patients (54.2±0.6 y, 63.3% female patients). EGJ morphology was categorized into type 1 (superimposed LES and crural diaphragm), type 2 (<3 cm separation between LES and crural diaphragm), and type 3 (≥3 cm separation). EGJ-contractile integral (EGJ-CI) and distal contractile integral (DCI) were extracted. Conventional EGJ and LES metrics, including basal and end-expiratory LES pressure, and LES length were also analyzed. Univariate and multivariate analyses were performed to determine the value of HRM parameters in predicting abnormal esophageal reflux burden.
Type 1 EGJ was noted in 298 (61.8%), type 2 in 125 (25.9%), and type 3 in 59 (12.2%); EGJ-CI and mean DCI were lower with abnormal EGJ morphology. Mean AET, and proportions with abnormal AET increased as EGJ morphology became progressively disrupted (P<0.0001 across groups); low EGJ-CI was additive in predicting abnormal AET. All HRM parameters assessed (EGJ morphology, EGJ-CI, and DCI) were independent predictors for abnormal AET (P≤0.02). Conventional LES and EGJ metrics were also associated with abnormal reflux burden, but intra-abdominal LES length, and hiatus hernia size did not independently predict total AET.
HRM-based EGJ morphology and EGJ barrier assessment independently predict esophageal reflux burden.
高分辨率测压（HRM）可利用新型软件工具对食管胃结合部（EGJ）形态进行特征描述，并对膈食管裂孔疝进行识别。
本研究的主要目的是确定基于 HRM 的 EGJ 和食管下括约肌（LES）指标对异常反流负担的预测作用。
在 482 例（54.2±0.6 岁，女性占 63.3%）接受治疗外的动态反流监测中提取总、直立和仰卧酸暴露时间（AET）。EGJ 形态分为 3 型：1 型（LES 和膈脚重叠）、2 型（LES 和膈脚之间距离＜3cm）和 3 型（LES 和膈脚之间距离≥3cm）。提取 EGJ 收缩积分（EGJ-CI）和远端收缩积分（DCI）。还分析了常规 EGJ 和 LES 指标，包括基础和呼气末 LES 压以及 LES 长度。进行单变量和多变量分析以确定 HRM 参数预测异常食管反流负担的价值。
1 型 EGJ 见于 298 例（61.8%）、2 型见于 125 例（25.9%）、3 型见于 59 例（12.2%）；异常 EGJ 形态时 EGJ-CI 和平均 DCI 较低。随着 EGJ 形态逐渐破坏，平均 AET 和出现异常 AET 的比例增加（各组间 P＜0.0001）；低 EGJ-CI 对预测异常 AET 具有附加作用。评估的所有 HRM 参数（EGJ 形态、EGJ-CI 和 DCI）均为异常 AET 的独立预测因子（P≤0.02）。常规 LES 和 EGJ 指标也与异常反流负担相关，但腹腔内 LES 长度和膈食管裂孔疝大小不能独立预测总 AET。
基于 HRM 的 EGJ 形态和 EGJ 屏障评估可独立预测食管反流负担。
