Division of Gastroenterology and Hepatology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, Taiwan, ROC.
Graduate Institute of Biomedical Materials and Tissue Engineering, Taipei Medical University, Taiwan, ROC.
Clin Transl Gastroenterol. 2022 Jul 1;13(7):e00511. doi: 10.14309/ctg.0000000000000511. Epub 2022 Jun 8.
The pathophysiology of functional dysphagia as defined by the updated Rome IV criteria is complex and remains largely unknown. We aimed to investigate its clinical characteristics and its association with psychosocial comorbidities.
Consecutive patients referred to our motility laboratory for evaluation of esophageal dysphagia were identified. All patients were assessed with upper endoscopy, high-resolution impedance manometry, and validated symptom questionnaires. Data from those who were diagnosed with functional dysphagia (n = 96) based on the Rome IV criteria were analyzed. Age- and sex-adjusted healthy volunteers were also enrolled for comparison. Psychiatric comorbidity and poor sleep quality were defined as total score of 5-item Brief Symptom Rating Scale ≥6 and Pittsburgh Sleep Quality Index ≥6, respectively.
The age peak of patients with functional dysphagia was at 40-60 years (47.9%) with females predominant (67%). Forty-four patients (45.8%) had psychiatric comorbidities, whereas 80 (83.3%) experienced poor sleep quality. Female patients were more likely to have trouble falling asleep, shorter sleep duration, and severe bloating. Compared with the healthy volunteers, patients with functional dysphagia had higher 5-item Brief Symptom Rating Scale and Pittsburgh Sleep Quality Index scores (5.34 ± 3.91 vs 1.84 ± 2.61, 9.64 ± 4.13 vs 4.77 ± 3.60, both P < 0.001) but similar results on high-resolution impedance manometry. Those with ineffective esophageal motility (16.7%) had less sleep efficiency than those with normal motility.
Patients with functional dysphagia were mainly middle-aged women and had a high prevalence of psychiatric comorbidities and sleep disturbances, especially in female patients. Patients with functional dysphagia displayed similar esophageal motility as the healthy volunteers did.
根据最新的罗马 IV 标准定义的功能性吞咽困难的病理生理学较为复杂，目前仍知之甚少。我们旨在研究其临床特征及其与心理社会共病的关系。
连续入组因食管吞咽困难而被转诊到我们运动实验室的患者。所有患者均接受上消化道内镜检查、高分辨率阻抗测压和经过验证的症状问卷评估。根据罗马 IV 标准诊断为功能性吞咽困难（n = 96）的患者的数据进行了分析。还招募了年龄和性别相匹配的健康志愿者作为对照。将 5 项简明症状评定量表总分≥6 和匹兹堡睡眠质量指数≥6 定义为存在精神共病和睡眠质量差。
功能性吞咽困难患者的年龄高峰在 40-60 岁（47.9%），女性占优势（67%）。44 例（45.8%）存在精神共病，80 例（83.3%）存在睡眠质量差。女性患者更可能入睡困难、睡眠时间较短和严重腹胀。与健康志愿者相比，功能性吞咽困难患者的 5 项简明症状评定量表和匹兹堡睡眠质量指数评分更高（5.34 ± 3.91 对 1.84 ± 2.61，9.64 ± 4.13 对 4.77 ± 3.60，均 P < 0.001），但高分辨率阻抗测压结果相似。食管动力障碍（16.7%）患者的睡眠效率低于正常动力障碍患者。
功能性吞咽困难患者主要为中年女性，存在较高的精神共病和睡眠障碍发生率，尤其是女性患者。功能性吞咽困难患者的食管动力与健康志愿者相似。
