Department of Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA.
Department of Medicine, Prisma Health, Greenville School of Medicine, Greenville, USA.
BMC Gastroenterol. 2022 Feb 21;22(1):74. doi: 10.1186/s12876-022-02165-5.
Intrabolus pressure (IBP) recorded by high-resolution manometry (HRM) portrays the compartmentalized force on a bolus during esophageal peristalsis. HRM may be a reliable screening tool for esophageal dysmotility in patients with elevated average maximum IBP (AM-IBP). Timed barium esophagram (TBE) is a validated measure of esophageal emptying disorders, such as esophagogastric junction outflow obstruction and achalasia. This study aimed to determine if an elevated AM-IBP correlates with esophageal dysmotility on HRM and/or delayed esophageal emptying on TBE.
A retrospective analysis of all HRM (unweighted sample n = 155) performed at a tertiary referral center from 09/2015-03/2017 yielded a case group (n = 114) with abnormal AM-IBP and a control group (n = 41) with a normal AM-IBP (pressure < 17 mmHg) as consistent with Chicago Classification 3. All patients received a standardized TBE, with abnormalities classified as greater than 1 cm of retained residual liquid barium in the esophagus at 1 and 5 min or as tablet retention after 5 min.
AM-IBP was significantly related to liquid barium retention (p = 0.003) and tablet arrest on timed barium esophagram (p = 0.011). A logistic regression model correctly predicted tablet arrest in 63% of cases. Tablet arrest on AM-IBP correlated with an optimal prediction point at 20.1 mmHg on HRM. Patients with elevated AM-IBP were more likely to have underlying esophageal dysmotility (95.6% vs. 70.7% respectively; p < 0.001), particularly esophagogastric junction outflow obstruction disorders. Elevated AM-IBP was associated with incomplete liquid bolus transit on impedance analysis (p = 0.002).
Our findings demonstrate that an elevated AM-IBP is associated with abnormal TBE findings of esophageal tablet retention and/or bolus stasis. An abnormal AM-IBP (greater than 20.1 mm Hg) was associated with a higher probability of retaining liquid bolus or barium tablet arrest on TBE and esophageal dysmotility on HRM. This finding supports the recent incorporation of IBP in Chicago Classification v4.0.
高分辨率测压法（HRM）记录的腔内压力（IBP）描绘了食管蠕动过程中对食团的分区压力。在平均最大 IBP（AM-IBP）升高的患者中，HRM 可能是一种可靠的食管动力障碍筛查工具。时间分辨钡餐造影（TBE）是一种验证食管排空障碍的方法，如食管胃结合部流出道梗阻和贲门失弛缓症。本研究旨在确定升高的 AM-IBP 是否与 HRM 上的食管动力障碍和/或 TBE 上的食管排空延迟相关。
对 2015 年 9 月至 2017 年 3 月在三级转诊中心进行的所有 HRM（未加权样本量 n=155）进行回顾性分析，得出异常 AM-IBP 的病例组（n=114）和正常 AM-IBP（压力<17mmHg）的对照组（n=41），符合芝加哥分类标准 3。所有患者均接受标准 TBE 检查，异常标准为 1 分钟和 5 分钟时食管内残留的钡剂大于 1cm，或 5 分钟后片剂残留。
AM-IBP 与液体钡剂潴留（p=0.003）和 TBE 上片剂滞留（p=0.011）显著相关。逻辑回归模型正确预测了 63%的片剂滞留病例。AM-IBP 上的片剂滞留与 HRM 上 20.1mmHg 的最佳预测点相关。AM-IBP 升高的患者更有可能存在潜在的食管动力障碍（分别为 95.6%和 70.7%；p<0.001），尤其是食管胃结合部流出道梗阻性疾病。升高的 AM-IBP 与阻抗分析中不完全液体团通过相关（p=0.002）。
我们的研究结果表明，升高的 AM-IBP 与 TBE 异常发现的食管片剂滞留和/或食团停滞相关。异常的 AM-IBP（大于 20.1mmHg）与液体团或钡剂片剂在 TBE 上滞留以及 HRM 上食管动力障碍的可能性更高相关。这一发现支持最近在芝加哥分类 v4.0 中纳入 IBP。
