Division of Digestive and Liver Diseases, Columbia University Irving Medical Center, New York, NY.
Department of Medicine.
J Clin Gastroenterol. 2021 Jul 1;55(6):499-504. doi: 10.1097/MCG.0000000000001390.
The goal of this study was to compare the clinical presentations of esophagogastric junction outflow obstruction (EGJOO) with coexisting abnormal esophageal body motility (EBM) to isolated EGJOO.
The clinical significance and management of EGJOO remain debated, as patients may have varied to no symptoms. The effect of coexisting abnormal EBM in EGJOO is unclear. We hypothesized that a concomitant EBM disorder is associated with clinical symptoms of EGJOO.
This was a retrospective cohort study of consecutive adults diagnosed with EGJOO on high-resolution impedance-manometry (HRIM) at 2 academic centers in March 2018 to September 2018. Patients with prior treatment for achalasia, foregut surgery, or evidence of obstruction were excluded. Subjects were divided into EGJOO with abnormal EBM per Chicago classification v3.0 and isolated EGJOO. Statistical analyses were performed using Fisher-exact or Student t test (univariate) and logistic or linear regression (multivariate).
Eighty-two patients (72% women, age 61.1±10.7 y) were included. Thirty-one (37.8%) had abnormal EBM, including 16 (19.5%) ineffective esophageal motility and 15 (18.2%) hypercontractile esophagus. Esophageal symptoms (heartburn, regurgitation, chest pain, dysphagia) were more prevalent among those with abnormal EBM (90.3% vs. 64.7%, P=0.01). On logistic regression adjusting for age, gender, body mass index, and opioid use, abnormal EBM remained predictive of esophageal symptoms (adjusted odds ratio [aOR] 7.51, P=0.007). On separate models constructed, HE was associated with chest pain (aOR 7.45, P=0.01) and regurgitation (aOR 4.06, P=0.046), while ineffective esophageal motility was predictive of heartburn (aOR 5.84, P=0.009) and decreased complete bolus transit (β-coefficient -0.177, P=0.04).
Coexisting abnormal EBM is associated with esophageal symptoms and bolus transit in patients with EGJOO.
本研究旨在比较胃食管交界处流出梗阻（EGJOO）伴合并异常食管体动力（EBM）与单纯 EGJOO 的临床表现。
EGJOO 的临床意义和处理仍存在争议，因为患者可能有不同程度的无症状。EGJOO 中同时存在的异常 EBM 的影响尚不清楚。我们假设并存的 EBM 障碍与 EGJOO 的临床症状有关。
这是 2018 年 3 月至 9 月在 2 个学术中心连续进行的高分辨率阻抗测压（HRIM）诊断为 EGJOO 的成年人的回顾性队列研究。排除既往贲门失弛缓症治疗、上消化道手术或梗阻证据的患者。根据芝加哥分类 v3.0 将患者分为 EGJOO 伴异常 EBM 和单纯 EGJOO。采用 Fisher 精确检验或 Student t 检验（单变量）和逻辑或线性回归（多变量）进行统计分析。
共纳入 82 例患者（72%为女性，年龄 61.1±10.7 岁）。31 例（37.8%）存在异常 EBM，包括 16 例无效食管动力（19.5%）和 15 例高收缩性食管（18.2%）。有异常 EBM 的患者食管症状（烧心、反流、胸痛、吞咽困难）更为常见（90.3%比 64.7%，P=0.01）。在校正年龄、性别、体重指数和阿片类药物使用后，异常 EBM 仍然与食管症状相关（调整后的优势比[aOR]7.51，P=0.007）。在分别构建的模型中，高收缩性食管与胸痛（aOR 7.45，P=0.01）和反流（aOR 4.06，P=0.046）相关，而无效食管动力与烧心（aOR 5.84，P=0.009）和完全食团通过减少相关（β系数-0.177，P=0.04）。
在 EGJOO 患者中，并存异常 EBM 与食管症状和食团通过相关。
