Department of Gastroenterology and Hepatology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
Division of Gastroenterology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
Aliment Pharmacol Ther. 2020 Jun;51(11):1130-1138. doi: 10.1111/apt.15758. Epub 2020 May 7.
Medications can affect gastrointestinal tract motility. However, their effects on oesophageal motility in particular are often not as widely known or may be underestimated.
To review the effect of existing medication use on high-resolution oesophageal manometry (HRM) in a 'real-world' setting.
Adult patients with upper gut symptoms and normal endoscopy or imaging who had HRM over a 22-month period were analysed. Achalasia and major disorders of peristalsis were excluded. All medications taken within 24 hours of the procedure were prospectively recorded and compared with HRM results, controlling for age, gender and proton pump inhibitor use.
A total of 502 patients (323 female, mean age 51) were recruited. Of these, 41.2% had normal oesophageal HRM, while 41.4% had ineffective oesophageal motility (IOM) and 7.6% had oesophagogastric junction outflow obstruction (OGJOO). Serotonin/norepinephrine reuptake inhibitors (SNRI) and opioids were associated with significantly higher resting lower oesophageal sphincter pressure. Benzodiazepines and opioids were associated with elevated integrated relaxation pressure. SNRI and inhaled beta-agonists were associated with increased distal contractile index, whereas calcium channel blockers were associated with a lower distal contractile index. Odds ratio of being on anticholinergics was higher in IOM patients vs normal (3.6, CI 1.2-10.8). Odds ratio for anticholinergics, inhaled beta-agonists, anticonvulsants, SNRIs and opioids (trend) were all > 3 for OGJOO patients vs normal.
Many medication classes are associated with abnormal HRM variables and diagnoses such as OGJOO and IOM; some of these associations are probably causal. These possible links should be taken into consideration during manometry interpretation.
药物会影响胃肠道动力。然而，它们对食管动力的影响通常不那么广为人知，或者可能被低估了。
在“真实世界”环境中，回顾现有药物使用对高分辨率食管测压（HRM）的影响。
对在 22 个月期间接受上消化道症状和正常内镜或影像学检查且进行 HRM 的成年患者进行分析。排除贲门失弛缓症和主要蠕动障碍。前瞻性记录所有在检查前 24 小时内服用的药物，并与 HRM 结果进行比较，同时控制年龄、性别和质子泵抑制剂的使用。
共纳入 502 例患者（323 例女性，平均年龄 51 岁）。其中，41.2%的患者 HRM 正常，41.4%的患者存在无效食管动力（IOM），7.6%的患者存在食管胃交界处流出梗阻（OGJOO）。5-羟色胺/去甲肾上腺素再摄取抑制剂（SNRI）和阿片类药物与静息食管下括约肌压力显著升高相关。苯二氮䓬类药物和阿片类药物与升高的整体松弛压力相关。SNRI 和吸入β激动剂与增加的远端收缩指数相关，而钙通道阻滞剂与较低的远端收缩指数相关。与正常组相比，IOM 患者服用抗胆碱能药物的比值比更高（3.6，95%CI：1.2-10.8）。与正常组相比，OGJOO 患者服用抗胆碱能药物、吸入β激动剂、抗惊厥药、SNRI 和阿片类药物（趋势）的比值比均>3。
许多药物类别与异常 HRM 变量和诊断相关，如 OGJOO 和 IOM；其中一些关联可能是因果关系。在解释测压时应考虑这些可能的联系。
