Penagini Roberto, de Bortoli Nicola, Savarino Edoardo, Arsiè Elena, Tolone Salvatore, Greenan Garrett, Visaggi Pierfrancesco, Maniero Daria, Mauro Aurelio, Consonni Dario, Gyawali C Prakash
Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
Gastroenterology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.
Clin Gastroenterol Hepatol. 2023 Jan;21(1):55-63. doi: 10.1016/j.cgh.2022.02.047. Epub 2022 Feb 28.
BACKGROUND & AIMS: Incomplete esophageal emptying is a key variable predicting symptom relapse after achalasia treatment. Although optimally evaluated using the timed barium esophagogram (TBE), incomplete esophageal emptying can also be identified on rapid drink challenge (RDC) performed during high-resolution manometry.
We evaluated if RDC differentiates complete from incomplete esophageal emptying in treated patients with achalasia, against a TBE gold standard. Unselected treated patients with achalasia with both TBE (200 mL of low-density barium suspension) and RDC (200 mL of water in sitting position) were enrolled in 5 tertiary referral centers. TBE barium column height at 1, 2, and 5 minutes were compared with RDC variables: pressurizations >20 mmHg, maximal RDC pressurization, proportion of RDC time occupied by pressurizations, trans-esophagogastric junction gradient, and integrated relaxation pressure.
Of 175 patients recruited (mean age, 59 years; 47% female), 138 (79%) were in clinical remission. Complete TBE emptying occurred in 45.1% at 1 minute, 64.0% at 2 minutes, and 73.1% at 5 minutes. RDC integrated relaxation pressure correlated strongly with TBE column height, and a 10-mmHg threshold discriminated complete from incomplete emptying at all 3 TBE time points with area under receiver operating characteristic curves of 0.85, 0.87, and 0.85, respectively. This threshold had high negative predictive values for complete emptying (88% at 2 minutes, 94% at 5 minutes), and modest positive predictive values for incomplete emptying (77% at 2 minutes, 62% at 5 minutes).
RDC during high-resolution manometry is an effective surrogate for TBE in assessing esophageal emptying in treated patients with achalasia.
食管排空不全是预测贲门失弛缓症治疗后症状复发的关键变量。虽然使用定时钡餐食管造影（TBE）评估最为理想，但在高分辨率测压期间进行的快速饮水试验（RDC）中也可识别食管排空不全。
我们以TBE作为金标准，评估RDC能否区分贲门失弛缓症治疗患者的食管排空完全与不全情况。5个三级转诊中心纳入了未经过筛选的贲门失弛缓症治疗患者，这些患者均接受了TBE（200 mL低密度钡剂混悬液）和RDC（坐位时饮用200 mL水）检查。将TBE在1分钟、2分钟和5分钟时的钡柱高度与RDC变量进行比较：压力>20 mmHg、最大RDC压力、压力所占RDC时间的比例、跨食管胃交界梯度以及综合松弛压。
共纳入175例患者（平均年龄59岁；47%为女性），其中138例（79%）处于临床缓解期。TBE在1分钟时完全排空的发生率为45.1%，2分钟时为64.0%，5分钟时为73.1%。RDC综合松弛压与TBE钡柱高度密切相关，10 mmHg的阈值在所有3个TBE时间点均可区分排空完全与不全，受试者操作特征曲线下面积分别为0.85、0.87和0.85。该阈值对完全排空具有较高的阴性预测值（2分钟时为88%，5分钟时为94%），对不全排空具有中等的阳性预测值（2分钟时为77%，5分钟时为62%）。
高分辨率测压期间的RDC是评估贲门失弛缓症治疗患者食管排空情况的有效替代TBE的方法。
