米兰评分可预测2型食管胃交界部患者的客观胃食管反流病。

The Milan Score Predicts Objective Gastroesophageal Reflux Disease in Patients With Type 2 Esophagogastric Junction.

作者信息

Ferrari Davide, Siboni Stefano, Sozzi Marco, Visaggi Pierfrancesco, Kristo Ivan, Tolone Salvatore, Marabotto Elisa, Bernardi Daniele, Schoppmann Sebastian F, Rogers Benjamin D, Hobson Anthony, Haworth Jordan, Lee Yeong Yeh, Louie Brian E, Masuda Takahiro, Ivy Megan L, Milito Pamela, Centorrino Erica, Theodorou Dimitrios, Triantafyllou Tania, Pasta Andrea, Calabrese Francesco, Tee Vincent, Cusmai Lorenzo, Penagini Roberto, Coletta Marina, Savarino Edoardo, Asti Emanuele, Gyawali C Prakash, De Bortoli Nicola

机构信息

Division of General and Emergency Surgery, IRCCS Policlinico San Donato, University of Milan, San Donato Milanese, Italy.

Division of Gastroenterology, University of Pisa, Pisa, Italy.

出版信息

Neurogastroenterol Motil. 2025 Jan 6:e14987. doi: 10.1111/nmo.14987.

DOI:10.1111/nmo.14987

PMID:39757994

Abstract

INTRODUCTION

High-resolution manometry (HRM) allows assessment of esophagogastric junction (EGJ) disruption. While type 3 EGJ predicts definitive gastroesophageal reflux disease (GERD), type 2 EGJ is less clearly implicated in GERD pathogenesis. This study aimed to characterize physiologic findings in type 2 EGJ to determine if the HRM-based Milan Score can define GERD within type 2 EGJ.

METHODS

535 patients with suspected GERD who underwent HRM and reflux monitoring were retrospectively analyzed. Clinical, HRM, and reflux study data were compared between the EGJ morphology subtypes, with objective GERD defined according to Lyon Consensus 2.0. The Milan Score, a novel metric that integrates ineffective esophageal motility, EGJ-contractile integral, EGJ morphology, and straight leg raise response, was abnormal when ≥ 137 (risk rate 50% for GERD). Receiver operating characteristic (ROC) curve analysis was performed to assess the accuracy of the Milan Score to predict objective GERD.

RESULTS

Type 3 EGJ was associated with the highest rate of objective GERD, followed by type 2 and type 1 EGJ (p < 0.001), with a corresponding stepwise increase in AET from type 1 to 3 EGJ (p < 0.001). Type 2 EGJ with Milan Score < 137 resembled type 1 EGJ (objective GERD in 23.6% vs. 33.2%, p = 0.09), and type 2 EGJ with score ≥ 137 resembled type 3 EGJ (objective GERD in 88.2% vs. 78.8%, p = 0.11). On ROC analysis, the Milan Score had an area under the curve of 0.858.

CONCLUSION

While type 2 EGJ includes varying GERD severity, the Milan Score can segregate patients at risk for objective GERD.

摘要

引言

高分辨率测压法（HRM）可用于评估食管胃交界部（EGJ）的破坏情况。虽然3型EGJ可预测明确的胃食管反流病（GERD），但2型EGJ与GERD发病机制的关联尚不太明确。本研究旨在描述2型EGJ的生理特征，以确定基于HRM的米兰评分是否能在2型EGJ中定义GERD。

方法

对535例接受HRM和反流监测的疑似GERD患者进行回顾性分析。比较EGJ形态学亚型之间的临床、HRM和反流研究数据，根据里昂共识2.0定义客观GERD。米兰评分是一种整合无效食管动力、EGJ收缩积分、EGJ形态和直腿抬高反应的新指标，当≥137时异常（GERD风险率50%）。进行受试者操作特征（ROC）曲线分析，以评估米兰评分预测客观GERD的准确性。

结果

3型EGJ的客观GERD发生率最高，其次是2型和1型EGJ（p<0.001），从1型到型EGJ的AET相应逐步增加（p<0.001）。米兰评分<137的2型EGJ类似于1型EGJ（客观GERD发生率分别为23.6%和33.2%，p=0.09），评分≥137的2型EGJ类似于3型EGJ（客观GERD发生率分别为88.2%和78.8%，p=0.11）。在ROC分析中，米兰评分的曲线下面积为0.858。