Division of Gastroenterology, Washington University School of Medicine, St Louis, MO.
Division of Gastroenterology, University of Louisville, Louisville, KY.
J Clin Gastroenterol. 2021 Feb 1;55(2):e8-e18. doi: 10.1097/MCG.0000000000001474.
The esophagogastric junction (EGJ) is a complex barrier between the thoracic and abdominal luminal gut compartments, comprised primarily of the lower esophageal sphincter (LES) and crural diaphragm. Although closed at rest, the EGJ relaxes to allow antegrade bolus transit and retrograde venting of air. Abnormal relaxation is the hallmark of achalasia spectrum disorders, while increased frequency of transient lower esophageal sphincter relaxations and/or EGJ disruption are seen in gastroesophageal reflux disease. High resolution manometry (HRM) is the modern day gold standard for assessment of EGJ morphology and function, with better performance characteristics compared with endoscopy and barium esophagography. Conventional LES metrics defining EGJ function include resting LES pressure as well as postswallow residual pressures. Newer HRM-based metrics include EGJ contractile integral, which measures static barrier function at rest, and EGJ morphology, which characterizes the relationship between LES and crural diaphragm. Provocative maneuvers assess dynamic EGJ function during physiological or pharmacologic stress. The most useful of these maneuvers, the rapid drink challenge, assesses for latent obstruction, while multiple rapid swallows evaluate adequacy of deglutitive inhibition. Amyl nitrate and cholecystokinin administration can segregate motor from structural obstruction. Newer provocative tests (straight leg raise maneuver, abdominal compression) and novel diagnostic tools (functional lumen imaging probe) complement HRM evaluation of the EGJ. Although current HRM metrics and maneuvers show promise in identifying clinically relevant EGJ abnormalities, future investigations evaluating management outcomes will improve segregation of normal from abnormal EGJ morphology and function.
胃食管交界处（EGJ）是胸腹腔之间的复杂屏障，主要由食管下括约肌（LES）和膈脚组成。虽然在休息时关闭，但 EGJ 会松弛以允许前向食团通过和逆行通气。异常松弛是贲门失弛缓症谱障碍的特征，而胃食管反流病则可见短暂性食管下括约肌松弛和/或 EGJ 破裂的频率增加。高分辨率测压（HRM）是评估 EGJ 形态和功能的现代金标准，与内镜和钡餐食管造影相比，具有更好的性能特征。定义 EGJ 功能的常规 LES 指标包括静息 LES 压力和吞咽后残余压力。基于 HRM 的新型指标包括 EGJ 收缩积分，它测量静息时的静态屏障功能，以及 EGJ 形态，它描述了 LES 和膈脚之间的关系。激发性操作在生理或药理应激下评估 EGJ 的动态功能。这些操作中最有用的是快速饮用法，评估潜在的梗阻，而多次快速吞咽评估吞咽抑制的充分性。硝酸戊酯和胆囊收缩素给药可以将运动与结构梗阻分开。新的激发性试验（直腿抬高试验、腹部压迫）和新的诊断工具（功能腔成像探头）补充了 HRM 对 EGJ 的评估。尽管目前的 HRM 指标和操作在识别临床上相关的 EGJ 异常方面显示出前景，但未来评估管理结果的研究将改善正常和异常 EGJ 形态和功能的区分。
