Stanford Esophageal Multidimensional Program in Innovation and Research Excellence (SEMPIRE), Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA 94305, USA.
Dis Esophagus. 2020 Mar 16;33(3). doi: 10.1093/dote/doz094.
Although High resolution esophageal manometry (HRM) is the gold standard to assess esophageal motility, little is known about the stability of the manometric diagnosis over time and its implications for management. To assess the stability and usefulness of repeat HRM in patients presenting with esophageal symptoms over time we performed this retrospective study of patients with esophageal symptoms. Medical records, questionnaires, and HRM tracing were independently reviewed using the Chicago classification. The primary objective was to assess the stability of the manometric diagnosis over time; secondary objective was its change (positive or negative). At least one repeat study was performed in 86 patients (36% women, ages 20-86, with mild to moderate symptoms), while 26 had a third procedure. Mean intervals between studies were 15 ± 1.6 months (for baseline v. first study) and 13 ± 0.8 months (for second to third study). Of the 27 patients initially with a normal study, 11 changed (five had esophago-gastric junction outflow obstruction [EGJOO], two diffuse esophageal spasm [DES], one jackhammer esophagus [JE], and three ineffective esophageal motility [IEM] [41% change]). Of the 24 patients with initial EGJOO, only nine retained it (65.2% change). Of nine patients with initial DES, four changed (44.4% change). Similarly, different diagnosis was seen in 7 of 24 initial IEM patients (22.7% change). Only one patient had achalasia initially and this remained stable. Additional changes were noted on a third HRM. Fluidity in the HRM diagnosis over time questions its validity at any timepoint and raises doubts about the need for intervention.
尽管高分辨率食管测压（HRM）是评估食管动力的金标准，但对于该方法在时间上的稳定性及其对管理的影响知之甚少。为了评估食管症状患者随时间重复 HRM 的稳定性和实用性，我们对这些患者进行了这项回顾性研究。使用芝加哥分类法对病历、问卷和 HRM 描记进行了独立审查。主要目的是评估随时间推移的测压诊断的稳定性；次要目的是其变化（阳性或阴性）。86 名患者（36%为女性，年龄 20-86 岁，症状轻至中度）至少进行了一次重复研究，26 名患者进行了第三次研究。研究之间的平均间隔为 15±1.6 个月（基线与第一次研究）和 13±0.8 个月（第二次与第三次研究）。在最初正常的 27 名患者中，有 11 名患者的结果发生了变化（5 名患者出现食管胃交界处流出梗阻[EGJOO]，2 名患者出现弥漫性食管痉挛[DES]，1 名患者出现贲门失弛缓症[JE]，3 名患者出现无效食管动力[IEM][41%的变化]）。在最初患有 EGJOO 的 24 名患者中，只有 9 名保留了该诊断（65.2%的变化）。最初患有 DES 的 9 名患者中有 4 名患者的结果发生了变化（44.4%的变化）。同样，在最初患有 IEM 的 24 名患者中，有 7 名患者的诊断也发生了变化（22.7%的变化）。只有 1 名患者最初患有贲门失弛缓症，且该诊断保持稳定。在第三次 HRM 中还发现了其他变化。食管测压诊断在时间上的多变性使其在任何时间点的有效性都受到质疑，并对干预的必要性提出了质疑。
