Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada.
Neurogastroenterol Motil. 2020 Nov;32(11):e13870. doi: 10.1111/nmo.13870. Epub 2020 May 14.
BACKGROUND: Jackhammer esophagus (JE) is a newly described esophageal motility disorder. However, there are limited data on JE and this entity remains misunderstood. METHODS: We performed a systematic review of clinical series on JE through MEDLINE, EMBASE, and Web of Science. Data from included studies were then extracted, and random-effects meta-analyses were performed. RESULTS: Thirty-eight studies met inclusion criteria. The pooled prevalence of JE was 1.97% [95% CI: 1.39%-2.78%] among patients referred for high-resolution manometry (HRM). The mean age at diagnosis was 60.8 years [95% CI: 57.1-64.4] and 65% [95% CI: 58%-72%] of patients were female. JE was significantly more prevalent in postlung transplant patients and morbidly obese patients undergoing HRM (23.99% [95% CI: 9.00%-38.97%] and 5.18% [95% CI: 1.76%-14.3%] respectively). Dysphagia was the most common presentation of JE (64% [95% CI: 52%-77%]) followed by gastroesophageal reflux disease (46% [95% CI: 26%-67%]). The pooled mean distal contractile integral (DCI) of all standard HRM swallows was 9249 mm Hg·s·cm [95% CI: 7834-10 663], and the pooled mean integrated relaxation pressure (IRP) was 13.9 mm Hg [95% CI: 8.2-19.7]. Overall, 73.6% [95% CI: 64.0%-83.1%] of JE patients who underwent treatment achieved clinical symptom improvement (79% [95% CI: 74%-85%] for endoscopic treatment and 63% [95% CI: 47%-79%] for medical treatment). The pooled clinical success rate of peroral endoscopic myotomy (POEM) specifically was 82% [95% CI: 75%-90%]. CONCLUSIONS: JE is a new motility disorder most commonly presenting with dysphagia. High clinical suspicion is important because the diagnosis can only be made through HRM.
背景:Jackhammer 食管(JE)是一种新描述的食管运动障碍。然而,关于 JE 的数据有限,这种疾病仍然存在误解。
方法:我们通过 MEDLINE、EMBASE 和 Web of Science 对 JE 的临床系列进行了系统评价。然后提取纳入研究的数据,并进行随机效应荟萃分析。
结果:38 项研究符合纳入标准。在接受高分辨率测压(HRM)检查的患者中,JE 的总患病率为 1.97%[95%置信区间:1.39%-2.78%]。诊断时的平均年龄为 60.8 岁[95%置信区间:57.1-64.4],65%[95%置信区间:58%-72%]的患者为女性。JE 在肺移植后患者和接受 HRM 的病态肥胖患者中更为常见(分别为 23.99%[95%置信区间:9.00%-38.97%]和 5.18%[95%置信区间:1.76%-14.3%])。吞咽困难是 JE 最常见的表现(64%[95%置信区间:52%-77%]),其次是胃食管反流病(46%[95%置信区间:26%-67%])。所有标准 HRM 吞咽的平均远端收缩积分(DCI)为 9249mmHg·s·cm[95%置信区间:7834-10663],平均整合松弛压力(IRP)为 13.9mmHg[95%置信区间:8.2-19.7]。总的来说,73.6%[95%置信区间:64.0%-83.1%]接受治疗的 JE 患者实现了临床症状改善(内镜治疗为 79%[95%置信区间:74%-85%],药物治疗为 63%[95%置信区间:47%-79%])。经口内镜肌切开术(POEM)的总体临床成功率为 82%[95%置信区间:75%-90%]。
结论:JE 是一种新的运动障碍,最常见的表现是吞咽困难。高度怀疑该病的存在非常重要,因为只有通过 HRM 才能做出诊断。
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