Department of Medicine, Duke University, 2301 Erwin Road, Durham, NC, 27710, USA.
Division of Gastroenterology, Duke University School of Medicine, 200 Morris Street, Suite 6524, Durham, NC, 27705, USA.
Dig Dis Sci. 2021 Nov;66(11):3968-3975. doi: 10.1007/s10620-020-06726-0. Epub 2020 Nov 28.
Esophagogastric junction outflow obstruction (EGJOO) is a common but nonspecific motility pattern identified by esophageal high-resolution manometry (HRM). Functional luminal impedance planimetry (FLIP) provides information regarding lower esophageal sphincter (LES) mechanics, which can identify achalasia spectrum disorders and is useful in evaluating EGJOO. However, the relationship between HRM and FLIP parameters in EGJOO is not clearly defined.
To identify predictors of abnormal FLIP findings in patients with non-mechanical EGJOO.
This is a retrospective cohort study of patients with non-mechanical EGJOO who underwent FLIP between 10/1/16 and 7/1/19. Demographic data including age and gender, examination indication, concomitant medications, HRM parameters, symptom burden, and FLIP metrics of diameter and distensibility index (DI) were collected. DI was categorized as not low (DI > 2.8), borderline low (DI 1.1-2.8), and definitely low (DI ≤ 1). Kruskal-Wallis and Fisher's exact tests were used to assess the relationship between HRM and FLIP parameters and to identify predictors of abnormal FLIP.
Among the 44 patients studied, most were female (n = 33, 75%) and the median age was 63. The median IRP was 18.2, and 10 (23%) patients used chronic narcotics. Lower total heartburn and regurgitation scores, and LES diameter by FLIP are associated with definitely low DI.
In patients with non-mechanical EGJOO, reflux burden scores and FLIP diameters can aid in predicting DI. These results may provide useful adjunctive data to help in differentiating which patients have meaningful outflow obstruction.
食管胃交界出口梗阻（EGJOO）是一种常见但非特异性的动力模式，通过食管高分辨率测压（HRM）来识别。功能性腔内阻抗平面图（FLIP）提供了有关下食管括约肌（LES）力学的信息，可识别贲门失弛缓症谱系障碍，并有助于评估 EGJOO。然而，EGJOO 中 HRM 和 FLIP 参数之间的关系尚不清楚。
确定非机械性 EGJOO 患者中异常 FLIP 结果的预测因素。
这是一项回顾性队列研究，纳入了 2016 年 10 月 1 日至 2019 年 7 月 1 日期间接受 FLIP 检查的非机械性 EGJOO 患者。收集了人口统计学数据，包括年龄和性别、检查指征、伴随用药、HRM 参数、症状负担以及直径和扩张指数（DI）的 FLIP 指标。DI 分为不低（DI>2.8）、临界低（DI 1.1-2.8）和明显低（DI≤1）。使用 Kruskal-Wallis 和 Fisher 确切检验评估 HRM 和 FLIP 参数之间的关系，并确定异常 FLIP 的预测因素。
在 44 名研究患者中，大多数为女性（n=33，75%），中位年龄为 63 岁。中位 IRP 为 18.2，10 名（23%）患者使用慢性麻醉性镇痛药。较低的总烧心和反流评分以及 FLIP 测量的 LES 直径与明显低的 DI 相关。
在非机械性 EGJOO 患者中，反流负担评分和 FLIP 直径有助于预测 DI。这些结果可能提供有用的辅助数据，有助于区分哪些患者存在有意义的流出道梗阻。
