Cha Boram, Choi Kyungmin, Jung Kee Wook, Kim Hwa Jung, Kim Ga Hee, Na Hee Kyong, Ahn Ji Yong, Lee Jeong Hoon, Choi Kee Don, Kim Do Hoon, Song Ho June, Lee Gin Hyug, Jung Hwoon-Yong, Joo Segyeong
Department of Internal Medicine, Digestive Disease Center, Inha University School of Medicine, Incheon, South Korea.
Department of Biomedical Engineering, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Neurogastroenterol Motil. 2023 Apr;35(4):e14452. doi: 10.1111/nmo.14452. Epub 2022 Aug 23.
Currently, there are no high-resolution impedance manometry (HRIM)-based diagnostic criteria for non-obstructive dysphagia (NOD). New impedance parameters, such as the esophageal impedance integral (EII) and volume of inverted impedance (VII) ratios, have shown strong correlations with bolus transit. This study compared the EII and VII ratios as diagnostic tools for NOD.
We analyzed 36 participants (12 patients with achalasia, 12 patients with NOD [7 with normal motility and 5 with ineffective esophageal motility], and 12 asymptomatic controls) who underwent HRIM with a maximum of 5 swallows per participant. The EII and VII ratios were calculated as Z2 (post-swallow)/Z1 (pre-swallow). Bolus transit was retrospectively evaluated using transluminal impedance analysis.
Both EII and VII ratios could effectively distinguish the achalasia group from the non-achalasia groups (area under the receiver operating characteristic curve [AUROC]: 0.83 for VII vs. 0.80 for EII; p = 0.73). However, the VII ratio was significantly better in discriminating asymptomatic controls from patients with dysphagia (NOD + achalasia) (AUROC: 0.81 vs. 0.68; p = 0.01). Moreover, the VII ratio was better in discriminating asymptomatic controls from patients with NOD (AUROC: 0.68 vs. 0.51; p = 0.06). In repeated swallows, the VII ratio was consistently the lowest in controls and the highest in patients with achalasia, whereas the EII ratio did not show a consistent pattern.
CONCLUSIONS & INFERENCES: The VII ratio was more reliable than the EII ratio for describing bolus transit and distinguishing patients with NOD from asymptomatic controls, even during repeated measures of subsequent swallows.
目前，尚无基于高分辨率阻抗测压法（HRIM）的非梗阻性吞咽困难（NOD）诊断标准。新的阻抗参数，如食管阻抗积分（EII）和倒置阻抗体积（VII）比值，已显示出与食团通过密切相关。本研究比较了EII和VII比值作为NOD诊断工具的效果。
我们分析了36名参与者（12例贲门失弛缓症患者、12例NOD患者[7例运动功能正常，5例食管运动功能无效]和12例无症状对照者），每位参与者最多进行5次吞咽的HRIM检查。EII和VII比值计算为Z2（吞咽后）/Z1（吞咽前）。使用腔内阻抗分析对食团通过情况进行回顾性评估。
EII和VII比值均能有效区分贲门失弛缓症组与非贲门失弛缓症组（受试者工作特征曲线下面积[AUROC]：VII为0.83，EII为0.80；p = 0.73）。然而，VII比值在区分无症状对照者与吞咽困难患者（NOD + 贲门失弛缓症）方面明显更好（AUROC：0.81对0.68；p = 0.01）。此外，VII比值在区分无症状对照者与NOD患者方面也更好（AUROC：0.68对0.51；p = 0.06）。在重复吞咽中，VII比值在对照组中始终最低，在贲门失弛缓症患者中最高，而EII比值未显示出一致的模式。
即使在后续吞咽的重复测量中，VII比值在描述食团通过以及区分NOD患者与无症状对照者方面比EII比值更可靠。
