Cha Boram, Jung Kee Wook
Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Korean J Gastroenterol. 2021 Feb 25;77(2):64-70. doi: 10.4166/kjg.2021.018.
Esophageal motility disorders were re-defined when high-resolution manometry was employed to better understand their pathogenesis. Newly developed parameters including integrated relaxation pressure (IRP), distal contractile integral, and distal latency showed better diagnostic yield compared with previously used conventional parameters. Therefore, Chicago classification was formulated, and its diagnostic cascade begins by assessing the IRP value. However, IRP showed limitation due to its inconsistency, and other studies have tried to overcome this. Recent studies showed that provocative tests, supplementing the conventional esophageal manometry protocol, have improved the diagnostic yield of the esophageal motility disorders. Therefore, position change from supine to upright, solid or semi-solid swallowing, multiple rapid swallows, and the rapid drink challenge were newly added to the manometry protocol in the revised Chicago classification version 4.0. Impedance planimetry enables measurement of bag cross-sectional area at various locations. The functional lumen imaging probe (FLIP) has been applied to assess luminal distensibility. This probe can also measure pressure, serial cross-sectional areas, and tension-strain relationship. The esophagogastric junction's distensibility is decreased in achalasia. Therefore, EndoFLIP can be used to assess contractility and distensibility of the esophagus in the patients with achalasia, including repetitive antegrade or retrograde contractions. EndoFLIP can detect achalasia patients with relatively low IRP, which was difficult to diagnose using the current high-resolution manometry. EndoFLIP also provides information on the contractile activity and distensibility of the esophageal body in patients with achalasia. The use of provocative tests, newly added in Chicago classification 4.0 version, and EndoFLIP can expand understanding of esophageal motility disorders.
当采用高分辨率测压法以更好地理解食管动力障碍的发病机制时，对其进行了重新定义。与先前使用的传统参数相比，新开发的参数包括综合松弛压（IRP）、远端收缩积分和远端潜伏期显示出更高的诊断率。因此，制定了芝加哥分类法，其诊断流程从评估IRP值开始。然而，IRP因其不一致性而存在局限性，其他研究试图克服这一问题。最近的研究表明，补充传统食管测压方案的激发试验提高了食管动力障碍的诊断率。因此，在修订的芝加哥分类4.0版中，测压方案中新增加了从仰卧位到直立位的体位改变、固体或半固体吞咽、多次快速吞咽以及快速饮水激发试验。阻抗平面测量法能够测量不同位置的气囊横截面积。功能性管腔成像探头（FLIP）已被用于评估管腔扩张性。该探头还可以测量压力、连续横截面积以及张力-应变关系。贲门失弛缓症患者食管胃交界处的扩张性降低。因此，EndoFLIP可用于评估贲门失弛缓症患者食管的收缩性和扩张性，包括重复性顺行或逆行收缩。EndoFLIP能够检测出IRP相对较低的贲门失弛缓症患者，而这用当前的高分辨率测压法很难诊断。EndoFLIP还能提供贲门失弛缓症患者食管体部收缩活动和扩张性的信息。芝加哥分类4.0版中新增加的激发试验的应用以及EndoFLIP能够拓展对食管动力障碍的认识。
