Rengarajan Arvind, Rogers Benjamin D, Wong Zhiqin, Tolone Salvatore, Sifrim Daniel, Serra Jordi, Savarino Edoardo, Roman Sabine, Remes-Troche Jose M, Ramos Rosa, Perez de la Serna Julio, Pauwels Ans, Leguizamo Ana Maria, Lee Yeong Yeh, Kawamura Osamu, Hayat Jamal, Hani Albis, Gonlachanvit Sutep, Cisternas Daniel, Carlson Dustin, Bor Serhat, Bhatia Shobna, Abrahao Luiz, Pandolfino John, Gyawali C Prakash
Division of Gastroenterology, Washington University School of Medicine in St Louis, St Louis, Missouri.
Gut Research Group, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia.
Clin Gastroenterol Hepatol. 2022 Mar;20(3):e398-e406. doi: 10.1016/j.cgh.2020.10.052. Epub 2020 Nov 2.
High-resolution manometry (HRM) is the current standard for characterization of esophageal body and esophagogastric junction (EGJ) function. We aimed to examine the prevalence of abnormal esophageal motor patterns in health, and to determine optimal thresholds for software metrics across HRM systems.
Manometry studies from asymptomatic adults were solicited from motility centers worldwide, and were manually analyzed using integrated relaxation pressure (IRP), distal latency (DL), and distal contractile integral (DCI) in standardized fashion. Normative thresholds were assessed using fifth and/or 95th percentile values. Chicago Classification v3.0 criteria were applied to determine motor patterns across HRM systems, study positions (upright vs supine), ages, and genders.
Of 469 unique HRM studies (median age 28.0, range 18-79 years). 74.6% had a normal HRM pattern; none had achalasia. Ineffective esophageal motility (IEM) was the most frequent motor pattern identified (15.1% overall), followed by EGJ outflow obstruction (5.3%). Proportions with IEM were lower using stringent criteria (10.0%), especially in supine studies (7.1%-8.5%). Other motor patterns were rare (0.2%-4.1% overall) and did not vary by age or gender. DL thresholds were close to current norms across HRM systems, while IRP thresholds varied by HRM system and study position. Both fifth and 95th percentile DCI values were lower than current thresholds, both in upright and supine positions.
Motor abnormalities are infrequent in healthy individuals and consist mainly of IEM, proportions of which are lower when using stringent criteria in the supine position. Thresholds for HRM metrics vary by HRM system and study position.
高分辨率测压法（HRM）是目前用于描述食管体部和食管胃交界处（EGJ）功能的标准方法。我们旨在研究健康人群中异常食管运动模式的患病率，并确定不同HRM系统软件指标的最佳阈值。
从全球各动力中心征集无症状成年人的测压研究数据，并采用综合松弛压（IRP）、远端潜伏期（DL）和远端收缩积分（DCI）进行标准化手动分析。使用第五和/或第95百分位数评估正常阈值。应用芝加哥分类v3.0标准确定不同HRM系统、研究体位（直立位与仰卧位）、年龄和性别的运动模式。
在469项独立的HRM研究中（中位年龄28.0岁，范围18 - 79岁），74.6%的HRM模式正常；无一人患贲门失弛缓症。无效食管动力（IEM）是最常见的运动模式（总体占15.1%），其次是EGJ流出道梗阻（5.3%）。采用严格标准时IEM的比例较低（10.0%），尤其是在仰卧位研究中（7.1% - 8.5%）。其他运动模式少见（总体占0.2% - 4.1%），且不随年龄或性别而变化。不同HRM系统的DL阈值接近当前标准，而IRP阈值因HRM系统和研究体位而异。直立位和仰卧位时，第五和第95百分位数的DCI值均低于当前阈值。
健康个体中运动异常不常见，主要为IEM，在仰卧位采用严格标准时其比例较低。HRM指标的阈值因HRM系统和研究体位而异。
