Division of Gastroenterology, Duke University School of Medicine, 200 Morris Street, Durham, NC, 27705, USA.
Duke University School of Medicine, Duke University, Durham, NC, USA.
Dysphagia. 2020 Oct;35(5):864-870. doi: 10.1007/s00455-020-10113-2. Epub 2020 Apr 10.
Gastroesophageal reflux disease and esophageal dysmotility are common in patients with advanced lung disease (ALD) and are associated with worse outcomes. Assessing esophageal function in these patients is relevant for determining pulmonary transplant eligibility and prognosticating post-transplant outcomes. Barium Swallow (BaS) is a non-invasive testing modality often performed as a complement to formal esophageal function tests (EFTs), but its role and clinical utility in this context is unknown. Therefore, we aimed to determine the relationship between BaS and EFTs with high-resolution manometry (HRM) and 24-h ambulatory pH-metry in patients with ALD. We performed a retrospective study of 226 consecutive patients undergoing evaluation for lung transplantation at a single center. All patients underwent EFTs and BaS independent of clinical history or symptoms per institutional protocol. Appropriate statistical tests were performed to evaluate the relationship between EFTs and BaS. Mucosal, reflux and motility findings were categorized. Abnormal motility was reported in 133 (59%) patients by BaS and 99 (44%) by HRM, with a significant difference in the proportions of patients with abnormal studies (p < 0.01). There were 7 (26%) patients with abnormal barium tablet passage who had normal HRM. The sensitivity (35%) and specificity (77%) for detecting pathologic reflux with BaS was poor. Inducibility of reflux and barium column height were not associated with pH-metry results. No clinically significant luminal irregularities were identified. In conclusion, while BaS can non-invasively assess esophageal mucosa, its findings are not associated with EFTs in patients with ALD.
胃食管反流病和食管动力障碍在晚期肺病（ALD）患者中很常见，并且与预后不良有关。评估这些患者的食管功能对于确定肺移植资格和预测移植后结局很重要。钡餐（BaS）是一种非侵入性测试方法，通常作为正式食管功能测试（EFT）的补充进行，但在这种情况下，其作用和临床实用性尚不清楚。因此，我们旨在确定钡餐与 EFT 与高分辨率测压（HRM）和 24 小时动态 pH 监测在 ALD 患者中的关系。我们对一家中心的 226 例连续接受肺移植评估的患者进行了回顾性研究。所有患者均根据机构方案独立于临床病史或症状进行 EFT 和钡餐检查。进行了适当的统计检验来评估 EFT 和钡餐之间的关系。对粘膜、反流和动力发现进行了分类。钡餐检查发现运动障碍 133 例（59%），HRM 检查发现运动障碍 99 例（44%），异常研究患者的比例存在显著差异（p<0.01）。有 7 例（26%）钡片通过异常的患者 HRM 正常。钡餐检测病理性反流的敏感性（35%）和特异性（77%）较差。反流的诱导性和钡柱高度与 pH 监测结果无关。未发现有临床意义的管腔不规则。总之，虽然钡餐可以无创性评估食管粘膜，但在 ALD 患者中，其结果与 EFT 无关。
