Department of Gastroenterology, University Hospitals of Dorset NHS Foundation Trust, Poole, UK.
Department of Medical Physics, University Hospitals of Dorset NHS Foundation Trust, Poole, UK.
Neurogastroenterol Motil. 2024 Apr;36(4):e14768. doi: 10.1111/nmo.14768. Epub 2024 Mar 15.
Gastric inlet patches are often incidental, but can also be a treatable cause of laryngo-esophageal symptoms.
We retrospectively reviewed all patients whose gastric inlet patches were diagnosed following assessment for laryngopharyngeal and swallowing symptoms. Improvement following Argon Plasma Coagulation (APC) was assessed using Minimum Clinically-Important Difference methodology combining voice, throat, and swallowing domains. Correlations between APC response and measures of reflux and mucosal barrier integrity, measured during 24-h pH-impedance manometry, were obtained. Proximal and Distal Mean Nocturnal Baseline Impedance (MNBI) values were separately calculated and the novel variable of Mucosal Impedance Gradient was derived as [((Distal MNBI-Proximal MNBI)/((Distal MNBI + Proximal MMBI)/2)) x 100].
Inlet patches were detected in 57 of 651 patients who had Transnasal Panendoscopy (8.7 ± 2.2%). There were 34 males. Mean age was 58 years. Mean duration of symptoms was 2 years. The commonest symptoms were hoarseness (n = 33), throat symptoms (n = 24), and dysphagia (n = 21), respectively. APC was used to ablate patches in 34 patients. Treatment response was 71% at a mean followup of 5.5 months. MIG > - 25% predicted response to APC, with area under the receiver operating characteristic curve of 0.875 (Sensitivity = 81%; Specificity = 100%; p < 0.0001).
Gastric inlet patches are common and under-recognized. They can cause protracted pharyngo-esophageal symptoms. Patch ablation is an effective treatment for carefully selected patients. Optimal patient selection requires multidisciplinary teamwork. Mucosal Impedance Gradient could further refine patient selection.
胃入口补丁通常是偶然发现的，但也可能是导致喉食管症状的可治疗原因。
我们回顾性分析了所有因喉咽和吞咽症状评估后诊断为胃入口补丁的患者。使用结合声音、喉咙和吞咽领域的最小临床重要差异方法评估氩等离子体凝固（APC）治疗后的改善情况。获得了 APC 反应与反流和黏膜屏障完整性测量值之间的相关性，这些测量值是在 24 小时 pH 阻抗测压期间获得的。分别计算近端和远端平均夜间基础阻抗（MNBI）值，并得出黏膜阻抗梯度的新变量[((远端 MNBI-近端 MNBI)/((远端 MNBI+近端 MMBI)/2))×100]。
在接受经鼻内镜检查的 651 例患者中（8.7±2.2%），发现了 57 例胃入口补丁。其中 34 例为男性，平均年龄为 58 岁，症状持续时间平均为 2 年。最常见的症状分别为声音嘶哑（n=33）、喉咙症状（n=24）和吞咽困难（n=21）。APC 用于消融 34 例患者的补丁。治疗后平均随访 5.5 个月，71%的患者有反应。MIG>-25%预测 APC 反应，ROC 曲线下面积为 0.875（敏感性=81%；特异性=100%；p<0.0001）。
胃入口补丁很常见，但认识不足。它们会导致长期的咽食管症状。对于精心挑选的患者，补丁消融是一种有效的治疗方法。最佳的患者选择需要多学科团队合作。黏膜阻抗梯度可以进一步优化患者选择。
