Wang K, Xu Z J, Ge Y, Xia Z W, Duan L P
Beijing Da Xue Xue Bao Yi Xue Ban. 2020 Oct 18;52(5):828-835. doi: 10.19723/j.issn.1671-167X.2020.05.006.
To analyze the causes of the esophagogastric junction outlet obstruction (EGJOO) patients, to discuss the differences of the clinical manifestation and esophageal motility characteristics between the anatomic EGJOO (A-EGJOO) and functional EGJOO (F-EGJOO) subgroups, and to search the diagnostic values of the specific metrics for differentiating the subgroups of EGJOO patients.
For the current retrospective study, all the patients who underwent the esophageal high resonance manometry test were retrospectively analyzed from Jan 2012 to Oct 2018 in Peking University Third Hospital. The EGJOO patients were enrolled in the following research. The clinical characteristics, such as symptoms and causes of the patients were studied. Then the patients were divided into two subgroups as A-EGJOO subgroup and F-EGJOO subgroup. The clinical symptoms and the main manometry metrics were compared between these two subgroups. The significant different metrics between the two groups were selected to draw receiver operating characteristic (ROC) curves and the diagnostic values were analyzed in differentiating the A-EGJOO and F-EGJOO subgroups.
The most common symptom of EGJOO was chest pain or chest discomfort (30.63%), then the dysphagia (29.73%), and acid regurgitation/heartburn (27.03%). Non-erosive reflux disease (36.04%) was the most popular cause for EGJOO, then the reflux esophagitis (17.12%). Besides the intra-EGJOO and extra-EGJOO lesions, the connective tissue disease (6.31%) and central nervous diseases (2.70%) were found to be the etiology of EGJOO. The causes of the rest 19 EGJOO were unknown. A-EGJOO patients presented significantly higher intra bolus pressure (IBP) than that of F-EGJOO [6.80 (5.20, 9.20) mmHg 5.10 (3.10, 7.60) mmHg, =0.016]. The area under curve of IBP was 0.637. When IBP≥5.15 mmHg, the sensitivity was 78.60% and specificity 50.70% to differentiate A- or F-EGJOO.
Chest pain or chest discomfort was the most common symptom in EGJOO patients. Besides the intraluminal structural disorders, the extra-luminal causes were found in EGJOO patients. A-EGJOO presented higher IBP than that of F-EGJOO patients. The cutoff value of IBP to differentiate A-EGJOO from EGJOO was 5.15 mmHg with sensitivity 78.06% and specificity 50.70%. However for the low area under curve, the diagnostic value of IBP was limited.
分析食管胃交界部出口梗阻（EGJOO）患者的病因，探讨解剖学EGJOO（A-EGJOO）和功能性EGJOO（F-EGJOO）亚组之间临床表现及食管动力特征的差异，探寻区分EGJOO患者亚组的特定指标的诊断价值。
在本回顾性研究中，对2012年1月至2018年10月于北京大学第三医院接受食管高分辨率测压检查的所有患者进行回顾性分析。将EGJOO患者纳入后续研究。研究患者的临床特征，如症状和病因。然后将患者分为A-EGJOO亚组和F-EGJOO亚组两个亚组。比较这两个亚组之间的临床症状和主要测压指标。选择两组之间有显著差异的指标绘制受试者工作特征（ROC）曲线，并分析其在区分A-EGJOO和F-EGJOO亚组中的诊断价值。
EGJOO最常见的症状是胸痛或胸部不适（30.63%），其次是吞咽困难（29.73%）和反酸/烧心（27.03%）。非糜烂性反流病（36.04%）是EGJOO最常见的病因，其次是反流性食管炎（17.12%）。除了EGJOO腔内和腔外病变外，还发现结缔组织病（6.31%）和中枢神经系统疾病（2.70%）是EGJOO的病因。其余19例EGJOO的病因不明。A-EGJOO患者的团注内压（IBP）显著高于F-EGJOO患者[6.80（5.20，9.20）mmHg对5.10（3.10，7.60）mmHg，P=0.016]。IBP的曲线下面积为0.637。当IBP≥5.15 mmHg时，区分A-EGJOO和F-EGJOO的敏感性为78.60%，特异性为50.70%。
胸痛或胸部不适是EGJOO患者最常见的症状。除腔内结构紊乱外，EGJOO患者还存在腔外病因。A-EGJOO患者的IBP高于F-EGJOO患者。区分A-EGJOO和F-EGJOO的IBP临界值为5.15 mmHg，敏感性为78.06%，特异性为50.70%。然而，由于曲线下面积较低，IBP的诊断价值有限。
