Tomik Jerzy, Sowula Klaudia, Dworak Mateusz, Stolcman Kamila, Maraj Małgorzata, Ceranowicz Piotr
ENT Department, Faculty of Medicine, Jagiellonian University Medical College, Jakubowskiego 2, 30-688 Kraków, Poland.
Department of Physiology, Faculty of Medicine, Jagiellonian University Medical College, Grzegórzecka 16, 31-531 Kraków, Poland.
Brain Sci. 2020 Nov 6;10(11):820. doi: 10.3390/brainsci10110820.
To detect the variations of esophageal peristalsis in amyotrophic lateral sclerosis (ALS) patients with predominantly bulbar or predominantly pseudobulbar clinical presentation by using esophageal manometry (EM). Fifteen ALS patients with pseudobulbar clinical presentation (PBP) and 13 patients with bulbar presentation (BP), fulfilling WFN Criteria, were studied. EM was performed in all subjects using a flexible catheter with solid-state transducers. Swallowing was initiated with 5 to 10 mL of water (wet swallows) and saliva (dry swallows) and repeated at 30 s intervals. The manometric parameters were measured automatically and visualized by the computer system. The tracings were analyzed using Synectics software. In PBP patients, an increase of resting pressure value in the upper esophageal sphincter (UES) >45 mmHg, a wave-like course of resting pressure, and toothed peristaltic waves were observed. In BP patients, a low amplitude of peristaltic waves <30 mmHg (mean: 17 ± 5) was recorded, without signs of esophageal motility disturbance at onset or during progression. EM procedure allows objectively distinguishing dysphagia in ALS patients due to bulbar syndrome from the dysphagia due to pseudobulbar syndrome. It is important to identify PBP patients because of their high risk of aspiration.
通过食管测压法（EM）检测以延髓为主或假性延髓为主临床表现的肌萎缩侧索硬化症（ALS）患者食管蠕动的变化。研究了15例符合世界神经病学联合会（WFN）标准的假性延髓临床表现（PBP）的ALS患者和13例延髓临床表现（BP）的患者。所有受试者均使用带有固态传感器的柔性导管进行食管测压。吞咽由5至10毫升水（湿吞咽）和唾液（干吞咽）引发，并每隔30秒重复一次。测压参数由计算机系统自动测量并可视化。使用Synectics软件分析记录曲线。在PBP患者中，观察到食管上括约肌（UES）静息压力值升高>45 mmHg，静息压力呈波浪状，以及锯齿状蠕动波。在BP患者中，记录到蠕动波振幅较低<30 mmHg（平均：17±5），在发病时或病程中无食管动力障碍迹象。食管测压程序能够客观地区分ALS患者因延髓综合征引起的吞咽困难和因假性延髓综合征引起的吞咽困难。识别PBP患者很重要，因为他们有较高的误吸风险。
