蠕动完整性的中断比食管胃结合部的收缩力或残余压力更能预测异常的食管食团清除。
Breaks in peristaltic integrity predict abnormal esophageal bolus clearance better than contraction vigor or residual pressure at the esophagogastric junction.
机构信息
Division of Gastroenterology, Washington University School of Medicine, St Louis, MO, USA.
Division of Gastroenterology, Hepatology, and Nutrition, University of Louisville School of Medicine, Louisville, KY, USA.
出版信息
Neurogastroenterol Motil. 2022 Feb;34(2):e14141. doi: 10.1111/nmo.14141. Epub 2021 Mar 27.
BACKGROUND
High-resolution impedance manometry (HRIM) evaluates esophageal peristalsis and bolus transit. We used esophageal impedance integral (EII), the ratio between bolus presence before and after an expected peristaltic wave, to evaluate predictors of bolus transit.
METHODS
From HRIM studies performed on 61 healthy volunteers (median age 27 years, 48%F), standard metrics were extracted from each of 10 supine water swallows: distal contractile integral (DCI, mmHg cm s), integrated relaxation pressure (IRP, mmHg), and breaks in peristaltic integrity (cm, using 20 mmHg isobaric contour). Pressure and impedance coordinates for each swallow were exported into a dedicated, python-based program for EII calculation (EII ratio ≥ 0.3 = abnormal bolus clearance). Univariate and multivariate analyses were performed to assess predictors of abnormal bolus clearance.
KEY RESULTS
Of 591 swallows, 80.9% were intact, 10.5% were weak, and 8.6% failed. Visual analysis overestimated abnormal bolus clearance compared to EII ratio (p ≤ 0.01). Bolus clearance was complete (median EII ratio 0.0, IQR 0-0.12) in 82.0% of intact swallows in contrast to 53.3% of weak swallows (EII ratio 0.29, IQR 0.0-0.57), and 19.6% of failed swallows (EII ratio 0.5, IQR 0.34-0.73, p < 0.001). EII correlated best with break length (ρ = 0.52, p < 0.001), compared to IRP (ρ: -0.17) or DCI (ρ: -0.42). On ROC analysis, breaks predicted abnormal bolus transit better than DCI or IRP (AUC 0.79 vs. 0.25 vs. 0.44, p ≤ 0.03 for each). On logistic regression, breaks remained independently predictive of abnormal bolus transit (p < 0.001).
CONCLUSIONS & INFERENCES: Breaks in peristaltic integrity predict abnormal bolus clearance better than DCI or IRP in healthy asymptomatic subjects.
背景
高分辨率阻抗测压（HRIM）评估食管蠕动和食团转运。我们使用食团存在比（EII），即在预期蠕动波前后食团存在的比值，来评估食团转运的预测因子。
方法
从 61 名健康志愿者（中位年龄 27 岁，48%为女性）的 HRIM 研究中，从 10 次仰卧位水吞咽中提取每个吞咽的标准指标：远端收缩积分（DCI，mmHg·cm·s）、整合松弛压（IRP，mmHg）和蠕动完整性中断（cm，使用 20mmHg 等压轮廓）。将每个吞咽的压力和阻抗坐标导出到一个专用的、基于 python 的程序中，用于 EII 计算（EII 比值≥0.3=异常食团清除）。进行单变量和多变量分析，以评估异常食团清除的预测因子。
主要结果
在 591 次吞咽中，80.9%是完整的，10.5%是弱的，8.6%是失败的。与 EII 比值相比，视觉分析高估了异常食团清除（p≤0.01）。在完整的吞咽中，82.0%的食团清除完全（中位数 EII 比值 0.0，IQR 0-0.12），而在弱的吞咽中为 53.3%（EII 比值 0.29，IQR 0.0-0.57），在失败的吞咽中为 19.6%（EII 比值 0.5，IQR 0.34-0.73，p<0.001）。EII 与中断长度的相关性最好（ρ=0.52，p<0.001），而与 IRP（ρ：-0.17）或 DCI（ρ：-0.42）的相关性较差。在 ROC 分析中，与 DCI 或 IRP 相比，中断更能预测异常食团转运（AUC 0.79 与 0.25 与 0.44，p≤0.03）。在逻辑回归中，中断仍然是异常食团转运的独立预测因子（p<0.001）。
结论
在健康无症状受试者中，蠕动完整性中断比 DCI 或 IRP 更能预测异常食团清除。
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