胡桃夹食管患者蠕动的扩张-收缩特征。
Distension-contraction profile of peristalsis in patients with nutcracker esophagus.
机构信息
Division of Gastroenterology, Department of Medicine, University of California San Diego, San Diego, CA, USA.
出版信息
Neurogastroenterol Motil. 2021 Nov;33(11):e14138. doi: 10.1111/nmo.14138. Epub 2021 Apr 5.
INTRODUCTION
High amplitude peristaltic esophageal contractions, that is, nutcracker esophagus, were originally described in association with "angina-like pain" of esophageal origin. However, significant number of nutcracker patients also suffer from dysphagia. High-resolution esophageal manometry (HRM) assesses only the contraction phase of peristalsis. The degree of esophageal distension during peristalsis is a surrogate of relaxation and can be measured from the intraluminal esophageal impedance measurements.
AIMS
Determine the amplitude of distension and temporal relationship between distension and contraction during swallow-induced peristalsis in nutcracker patients.
METHODS
HRM impedance (HRMZ) studies were performed and analyzed in 24 nutcracker and 30 normal subjects in the Trendelenburg position. A custom-built software calculated the numerical data of the amplitudes of distension and contraction, the area under the curve (AUC) of distension and contraction, and the temporal relationship between distension and contraction.
RESULTS
In normal subjects, the distension peaks similar to contraction traverse sequentially the esophagus. The amplitude of contraction is greater in the nutcracker esophagus but the amplitude of distension and area under the curve of distension are smaller in patients compared to controls. Distension peaks are aligned closely with contraction in normal subjects, but in patients, the bolus travels faster to the distal esophagus, resulting in a smaller time interval between the onset of swallow and distension peak. Receiver operative characteristics (ROC) curve reveals high sensitivity and specificity of the above parameters in patients.
CONCLUSION
Abnormalities in the distension phase of peristalsis are a possible mechanism of dysphagia in patients with nutcracker esophagus.
简介
高振幅蠕动性食管收缩，即胡桃夹食管，最初与食管起源的“类似心绞痛样疼痛”相关联而被描述。然而，相当数量的胡桃夹食管患者也有吞咽困难。高分辨率食管测压（HRM）仅评估蠕动的收缩相。蠕动过程中食管扩张的程度是松弛的替代指标，可以通过腔内食管阻抗测量来测量。
目的
确定胡桃夹患者吞咽诱导蠕动时扩张的幅度以及扩张与收缩之间的时间关系。
方法
对 24 例胡桃夹患者和 30 例正常对照者进行 HRM 阻抗（HRMZ）研究和分析，均采用特伦德伦堡位。定制软件计算了扩张和收缩的幅度、扩张和收缩的曲线下面积（AUC）以及扩张和收缩之间的时间关系的数值数据。
结果
在正常对照组中，扩张峰值类似于收缩依次穿过食管。胡桃夹食管的收缩幅度较大，但与对照组相比，患者的扩张幅度和扩张的 AUC 较小。在正常对照组中，扩张峰值与收缩紧密对齐，但在患者中，食团更快地向食管远端移动，导致吞咽和扩张峰值之间的时间间隔较小。受试者工作特征（ROC）曲线显示，上述参数对患者具有较高的敏感性和特异性。
结论
蠕动扩张相的异常可能是胡桃夹食管患者吞咽困难的一种机制。
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