酸相关吞咽困难的自然病史中的食管动力障碍及其对患者生活质量的影响——一项前瞻性队列研究。
Esophageal Motility Disorders in the Natural History of Acid-Dependent Causes of Dysphagia and Their Influence on Patients' Quality of Life-A Prospective Cohort Study.
机构信息
Department of Gastroenterology and Hepatology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland.
Department of Pharmacology, Wroclaw Medical University, Mikulicza-Radeckiego 2, 50-345 Wroclaw, Poland.
出版信息
Int J Environ Res Public Health. 2021 Oct 23;18(21):11138. doi: 10.3390/ijerph182111138.
BACKGROUND
Esophageal dysmotility may be the cause or a secondary effect of gastric acid-dependent diseases: erosive reflux disease (ERD), Schatzki ring (SR) and eosinophilic esophagitis (EoE).
METHODS
This study aims to compare concomitant dysphagia with ERD, SR and EoE, considering manometric patterns, their role in the natural history and their impact on assessing quality of life. Fifty-eight patients with dysphagia underwent high-resolution manometry and esophago-gastro-duodenoscopy (EGD) with an assessment of SR, ERD and sampling for EoE, completed a questionnaire with the Eating Assessment Tool (EAT-10) and the Gastrointestinal Quality of Life Index. Based on endoscopic images and the histopathological criterion of EoE (≥15 eosinophils/high-power field), patients were assigned to groups with ERD, EoE, SR and with normal endoscopic and histopathological images. In the data analysis, ≤ 0.05 was considered statistically significant. This trial was registered with ClinicalTrials.gov (no. NCT04803162).
RESULTS
Both EoE, SR and ERD correlate with ineffective motility. In ERD, normal peristalsis precedes the development of the disease, unlike EoE, which develops later and leads to absent contractility. The development of SR is associated with disorders of the upper esophageal sphincter (UES). In the group with SR and ERD, UES insufficiency significantly reduces the quality of life. Patients with normal esophagus in EGD scored the lowest quality of life and those with SR had the most severe dysphagia.
CONCLUSION
The esophageal motility disorders co-occurring with endoscopic and histological anomalies do not significantly affect the severity of dysphagia, however, in the case of patients with ERD and SR and concomitant UES insufficiency, this motor dysfunction has a significant impact on the reduction in the patients' quality of life. Although no specific esophageal motility pattern typical of EoE, ERD and SR has been identified, comparative assessment of manometric features may have a potential role in differential diagnosis.
背景
食管动力障碍可能是胃酸依赖性疾病（糜烂性反流病 ERD、Schatzki 环 SR 和嗜酸性食管炎 EoE）的病因或继发效应。
方法
本研究旨在比较同时存在的吞咽困难与 ERD、SR 和 EoE，考虑到测压模式、它们在自然史中的作用及其对评估生活质量的影响。58 例吞咽困难患者接受了高分辨率测压和食管胃十二指肠镜检查（EGD），评估了 SR、ERD 和 EoE 的采样，完成了 Eating Assessment Tool（EAT-10）和胃肠道生活质量指数的问卷。根据内镜图像和 EoE 的组织病理学标准（≥15 个嗜酸性粒细胞/高倍视野），患者被分为 ERD、EoE、SR 组和内镜及组织病理学图像正常组。数据分析中，P 值<0.05 被认为具有统计学意义。该试验在 ClinicalTrials.gov 注册（编号 NCT04803162）。
结果
EoE、SR 和 ERD 均与无效动力相关。在 ERD 中，正常蠕动先于疾病的发展，而 EoE 则不同，它发展较晚并导致无收缩力。SR 的发展与上食管括约肌（UES）障碍有关。在 SR 和 ERD 组中，UES 功能不全显著降低了生活质量。在 EGD 中，食管正常的患者生活质量评分最低，而 SR 患者的吞咽困难最严重。
结论
与内镜和组织学异常同时存在的食管动力障碍不会显著影响吞咽困难的严重程度，然而，在 ERD 和 SR 患者且伴有UES 功能不全的情况下，这种运动功能障碍对降低患者的生活质量有显著影响。尽管没有发现 EoE、ERD 和 SR 的特定食管动力模式，但对测压特征的比较评估可能在鉴别诊断中具有潜在作用。
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