Division of Gastroenterology, Hepatology & Nutrition, Center for Motility and Functional Gastrointestinal Disorders, Boston Children's Hospital, Boston, MA.
GI Cares for Kids, Atlanta, GA Neurogastroenterology and Motility Program Children's Healthcare of Atlanta, Atlanta, GA.
J Pediatr Gastroenterol Nutr. 2022 Apr 1;74(4):523-528. doi: 10.1097/MPG.0000000000003394. Epub 2022 Feb 3.
Functional luminal imaging probes (FLIP) have been used by multiple centers to assess esophagogastric junction (EGJ) function in patients at risk for esophageal obstruction but its role in diagnosing peristaltic disorders is less well studied. In particular, there are no studies comparing the sensitivity of FLIP to diagnose motility abnormalities and impaired bolus transit by high-resolution esophageal manometry with impedance.
We prospectively recruited 42 patients undergoing high-resolution esophageal manometry with impedance (HRIM) who also underwent FLIP between 2018 and 2020. HRIM parameters were analyzed using Swallow Gateway software to determine peristaltic and lower esophageal sphincter pressure measurements as well as bolus flow parameters. FLIP tracings were analyzed for the presence of repetitive antegrade contractions (RACs), EGJ distensibility, and associated parameters.
Forty-two patients were included (11 controls, 7 achalasia, 16 fundoplication, 8 dysmotility). The mean age of patients was 10.1 ± 0.9 years. There were significant differences in bolus flow parameters across diagnosis with longer bolus presence (BPT) in control patients compared with fundoplication and dysmotility patients. There was a significant correlation between EGJ diameter, EGJ distensibility and bolus flow time (BFT) for solid foods (r2 > 0.518, P < 0.02). The presence of RACs and EGJ relaxation during RACs was associated with a greater BFT and BPT across textures (P < 0.05). Forty-two percentage of patients with absent RACs, however, had clear peristalsis by HRIM.
The presence of RACs and EGJ relaxation by FLIP correlate with improved bolus flow. Patients with an absence of RACs need HRIM to confirm any diagnoses of dysmotility.
功能性腔内成像探针 (FLIP) 已被多个中心用于评估有食管梗阻风险的患者的食管胃结合部 (EGJ) 功能，但它在诊断蠕动障碍方面的作用研究较少。特别是，目前尚无研究比较 FLIP 诊断动力障碍和高分辨率食管测压与阻抗法评估的吞咽障碍的敏感性。
我们前瞻性地招募了 42 名在 2018 年至 2020 年期间接受高分辨率食管测压与阻抗 (HRIM) 检查的患者，他们还接受了 FLIP 检查。使用吞咽网关软件分析 HRIM 参数，以确定蠕动和食管下括约肌压力测量以及食团流动参数。分析 FLIP 轨迹以确定是否存在重复性顺行收缩 (RAC)、EGJ 可扩张性以及相关参数。
共纳入 42 名患者（11 名对照、7 名贲门失弛缓症、16 名胃底折叠术、8 名动力障碍）。患者的平均年龄为 10.1±0.9 岁。不同诊断之间的食团流动参数存在显著差异，与胃底折叠术和动力障碍患者相比，对照组患者的食团存在时间 (BPT) 更长。固体食物的 EGJ 直径、EGJ 可扩张性与食团流动时间 (BFT) 之间存在显著相关性（r2＞0.518，P＜0.02）。RAC 期间存在 RAC 和 EGJ 松弛与各种质地的 BFT 和 BPT 增加相关（P＜0.05）。然而，42%无 RAC 的患者通过 HRIM 显示存在明确的蠕动。
FLIP 检测到的 RAC 和 EGJ 松弛与改善的食团流动有关。无 RAC 的患者需要 HRIM 来确认任何动力障碍的诊断。
