Domingues Gerson Ricardo, Michelsohn Nelson Henrique, Viebig Ricardo Guilherme, Chinzon Décio, Nasi Ary, Andrade Carla Granja, Lemme Eponina Maria, AbrahÃo Junior Luiz João, Bravim Mauricio Gustavo, Nobre-E-Souza Miguel Ângelo, Carvalho Nayara Salgado, Carvalho Paulo J P C, Rodrigues Tomás Navarro, Moraes Filho Joaquim Prado P
Universidade do Estado do Rio de Janeiro, Departamento de Medicina Interna, Disciplina de Gastroenterologia, Rio de Janeiro, RJ, Brasil.
Centro de Motilidade Digestiva (CDM), São Paulo, SP, Brasil.
Arq Gastroenterol. 2020 Apr-Jun;57(2):209-215. doi: 10.1590/S0004-2803.202000000-40.
The high-resolution manometry has been a significant advance in esophageal diagnostics. There are different types of catheter and systems devices to capture esophageal pressures that generate variable data related to Chicago Classification (CC) and consequently influence normal values results. There are not normative data for the 24-channel water-perfused high-resolution manometry system most used in Brazil with healthy volunteers in supine posture.
To determine manometric esophageal normative values for a 24-channel water-perfused high-resolution manometry catheter in supine posture using healthy volunteers according to CC 3.0 parameters.
A total of 92 volunteers with no gastrointestinal symptoms or medications affecting GI motility underwent esophageal high-resolution manometry by standard protocol. Age, gender and manometry parameters analyzed using Alacer software were collected. The median, range, and 5th and 95th percentiles (where applicable) were obtained for all high-resolution manometry metrics. Normal value percentiles were defined as 95th integrated relaxation pressure, 5th-100th distal contractile integral, and 5th distal latency.
The mean age was 40.5±13.2 years. Our normative metrics were integrated relaxation pressure <16 mmHg and distal contractile integral (708-4111 mmHg.cm.s) distal latency was <6 s and peristaltic break size (>4 cm). For EGJ-CI the range 5th-95th was 21.7-86.9 mmHg.cm.s.
This is the first report of normative data for the 24-channel water-perfused system in supine posture. It revealed higher integrated relaxation pressure and distal latency duration which suggest the need to change CC 3.0 cutoffs for this system. It is observed that there is a tendency that DCI >7000 mmHg.cm.s may represent the lower limit of hypercontractility, and when <700 mmHg.cm.s (<5% percentile) interpreted as ineffective esophageal motility or failcontraction. Also compared to Chicago 3.0, higher integrated relaxation pressure and duration of distal latency were found. We emphasize that these data must be confirmed by future studies.
高分辨率测压法是食管诊断领域的一项重大进展。有不同类型的导管和系统设备用于获取食管压力，这些设备会产生与芝加哥分类（CC）相关的可变数据，从而影响正常值结果。在巴西，对于最常用的24通道水灌注高分辨率测压系统，尚无针对仰卧姿势健康志愿者的规范数据。
根据CC 3.0参数，使用健康志愿者确定24通道水灌注高分辨率测压导管在仰卧姿势下的食管测压规范值。
共有92名无胃肠道症状且未服用影响胃肠动力药物的志愿者按照标准方案接受食管高分辨率测压。收集年龄、性别以及使用Alacer软件分析的测压参数。获取所有高分辨率测压指标的中位数、范围以及第5和第95百分位数（如适用）。正常价值百分位数定义为第95整合松弛压、第5 - 100远端收缩积分以及第5远端潜伏期。
平均年龄为40.5±13.2岁。我们的规范指标为整合松弛压<16 mmHg，远端收缩积分（708 - 4111 mmHg.cm.s），远端潜伏期<6秒，蠕动中断大小（>4 cm）。对于EGJ - CI，第5 - 95百分位数范围为21.7 - 86.9 mmHg.cm.s。
这是关于24通道水灌注系统在仰卧姿势下规范数据的首次报告。它显示出较高的整合松弛压和远端潜伏期，这表明需要改变该系统的CC 3.0临界值。观察到DCI>7000 mmHg.cm.s可能代表高收缩性的下限，而当<700 mmHg.cm.s（<第5百分位数）时解释为食管动力无效或收缩失败。此外，与芝加哥3.0相比，发现整合松弛压和远端潜伏期持续时间更高。我们强调这些数据必须通过未来的研究加以证实。
