食管测压对贲门失弛缓症的诊断是否必要？通过食管清除法识别贲门失弛缓症患者。
Is esophageal manometry essential for the diagnosis of achalasia? Identifying patients with achalasia by the esophageal clearance method.
机构信息
Department of Surgery, Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minato-ku, Tokyo, 105-8461, Japan.
出版信息
Esophagus. 2021 Jan;18(1):163-168. doi: 10.1007/s10388-020-00756-3. Epub 2020 Jun 17.
BACKGROUND AND AIM
Achalasia is a disease characterized by inadequate relaxation of the lower esophageal sphincter (LES) and impaired peristalsis, for which esophageal motor function testing is essential in making a definitive diagnosis. However, the diffusion rate of esophageal pressure testing in Japan is low. We, therefore, examined whether achalasia could be identified by esophageal clearance testing with low-density barium (Timed Barium Esophagogram: TBE).
MATERIALS AND METHODS
126 cases (62 males, median age of 46 years), excluding those who had not undergone TBE during their initial laparoscopic Heller-Dor surgery, were chosen as the subjects from among those who were diagnosed with achalasia from November 2012 when HRM was introduced. The type of dilation, maximum esophageal transverse diameter, and esophageal clearance measurements by TBE were retrospectively examined. With respect to TBE, 200 mL of 45 weight% low-density barium was ingested as quickly as possible, after which the barium column heights (H0, H1, H2, and H5) were measured 1 min, 2 min, and 5 min following ingestion.
RESULTS
The types of dilation indicated included: straight type (105 cases, 83%); sigmoid type (20 cases, 16%); and advanced sigmoid type (1 case, 1%). The maximum transverse diameter of the esophagus was 45 (34-54) mm, with Grade I (d < 30 mm) in 33 cases, Grade II (35 mm < d < 60 mm) in 75 cases, and Grade III (d < 60 mm) in 18 cases. The values for H0, H1, H2, and H5 were 162 (117-201) mm, 142 (98-199) mm, 130 (94-183) mm, and 119 (77-178) mm, respectively. 114 cases (90.5%) were not cleared after 5 min, while 12 cases (9.5%) were cleared by 5 min later (H1 = 0 + H2 = 0 + H5 = 0) and 7 cases (5.6%) by 2 min later (H1 = 0 + H2 = 0), with only 6 cases (4.8%) having complete clearance within 1 min (H1 = 0). Moreover, the degree of dilatation in patients with complete clearance within 1 min was three patients (2.4%) each for Grade I and Grade II, respectively.
CONCLUSIONS
Approximately 2.4% of achalasia cases had mostly normal esophageal clearance and no esophageal dilation. Based on the state of esophageal clearance by TBE and the maximum transverse diameter of the esophagus, it seems by and large possible to identify achalasia cases.
背景与目的
贲门失弛缓症是一种以食管下括约肌（LES）松弛不足和蠕动受损为特征的疾病，对食管运动功能进行测试对于明确诊断至关重要。然而，日本食管压力测试的普及程度较低。因此，我们通过低浓度钡剂食管清除试验（Timed Barium Esophagogram：TBE）来检测贲门失弛缓症。
材料和方法
从 2012 年 11 月开始使用 HRM 诊断为贲门失弛缓症的患者中，选择 126 例（62 例男性，中位年龄 46 岁），排除了初次腹腔镜 Heller-Dor 手术中未行 TBE 的患者。回顾性检查 TBE 时的扩张类型、最大食管横径和食管清除测量值。对于 TBE，快速摄入 200 毫升 45 重量%的低浓度钡剂，摄入后 1 分钟、2 分钟和 5 分钟分别测量钡柱高度（H0、H1、H2 和 H5）。
结果
扩张类型包括：直型（105 例，83%）；乙状结肠型（20 例，16%）；和高级乙状结肠型（1 例，1%）。食管最大横径为 45（34-54）mm，其中 33 例为Ⅰ级（d＜30mm），75 例为Ⅱ级（35mm＜d＜60mm），18 例为Ⅲ级（d＜60mm）。H0、H1、H2 和 H5 的值分别为 162（117-201）mm、142（98-199）mm、130（94-183）mm 和 119（77-178）mm。114 例（90.5%）5 分钟后未清除，12 例（9.5%）5 分钟后清除（H1=0+H2=0+H5=0），7 例（5.6%）2 分钟后清除（H1=0+H2=0），仅 6 例（4.8%）在 1 分钟内完全清除（H1=0）。此外，在 1 分钟内完全清除的患者中，扩张程度分别为Ⅰ级和Ⅱ级各有 3 例（2.4%）。
结论
贲门失弛缓症患者中约有 2.4%的患者食管清除基本正常且无食管扩张。根据 TBE 的食管清除状态和食管最大横径，可以基本确定贲门失弛缓症患者。
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