Division of Gastroenterology, Washington University School of Medicine, St Louis, MO, USA.
Unit of Gastroenterology, Campus Bio Medico University, Rome, Italy.
Neurogastroenterol Motil. 2021 Feb;33(2):e13973. doi: 10.1111/nmo.13973. Epub 2020 Aug 16.
Postreflux swallow-induced peristaltic wave (PSPW) on pH-impedance monitoring and contraction vigor on high-resolution manometry (HRM) both assess esophageal peristaltic response. We aimed to evaluate relationships between PSPW and esophageal peristalsis on HRM in the context of reflux disease in this multicenter cohort study.
pH-impedance and HRM studies performed on patients with persisting reflux symptoms were reviewed from 6 centers (5 in Europe and 1 in US). Total, upright and supine acid exposure time (AET) were evaluated from pH-impedance studies; PSPW index (PSPWI) and mean nocturnal baseline impedance (MNBI) were calculated using standard methodology. Esophageal body contraction vigor was analyzed using distal contractile integral (DCI), and DCI ratio > 1 between single swallows and multiple rapid swallows (MRS) defined presence of contraction reserve. Student's t test, ANOVA, and linear regression were utilized to investigate relationships between PSPW, contraction vigor, and contraction reserve.
Of 296 patients (52.8 ± 0.8 yr, 63% F), median PSPWI was 0.475. Only 24.0% had intact DCI; the remainder had varying degrees of hypomotility. As hypomotility increased, PSPWI and MNBI decreased significantly, while total AET and reflux episodes had an inverse response (P ≤ .002 for each). MRS data were available in 167 (56.4%), 72.5% had contraction reserve. MRS cohorts with normal PSPWI had significantly lower reflux burden compared to low PSPWI, regardless of presence or absence of contraction reserve (P ≤ .001).
PSPWI correlates with esophageal hypomotility and reflux burden, and complements clinical reflux evaluation. Intact PSPW is more relevant to esophageal reflux clearance than contraction reserve.
反流吞咽后蠕动波（PSPW）在 pH 阻抗监测和高分辨率测压（HRM）中的收缩力度均可评估食管蠕动反应。在这项多中心队列研究中，我们旨在评估反流疾病背景下 PSPW 与 HRM 下食管蠕动之间的关系。
从 6 个中心（欧洲 5 个，美国 1 个）回顾了 pH 阻抗和 HRM 研究的患者资料。通过 pH 阻抗研究评估总、直立和仰卧酸暴露时间（AET）；采用标准方法计算 PSPW 指数（PSPWI）和夜间平均基础阻抗（MNBI）。采用远端收缩积分（DCI）分析食管体收缩力度，单次吞咽和多次快速吞咽（MRS）之间 DCI 比值>1 定义为收缩储备存在。采用 Student t 检验、方差分析和线性回归来研究 PSPW、收缩力度和收缩储备之间的关系。
在 296 名患者中（52.8±0.8 岁，63%为女性），中位 PSPWI 为 0.475。仅有 24.0%的患者 DCI 正常；其余患者存在不同程度的蠕动减弱。随着蠕动减弱的增加，PSPW 和 MNBI 显著降低，而总 AET 和反流事件呈相反反应（P≤0.002 ）。167 名患者（56.4%）有 MRS 数据，72.5%有收缩储备。无论是否存在收缩储备，PSPW 正常的 MRS 组的反流负担明显低于 PSPWI 低的 MRS 组（P≤0.001）。
PSPW 与食管蠕动减弱和反流负担相关，并补充了临床反流评估。完整的 PSPW 比收缩储备更与食管反流清除相关。
