Mittal Ravinder K, Gupta Anant, Fu Jerry, Stark Paul, Candipali Shreeya, Sun Lixin, Nemeh Carlos, Sharma Arshia, Zifan Ali
Department of Medicine, Division of Gastroenterology, University of California, San Diego, California, USA.
Department of Radiology, San Diego VA Medical Center, San Diego, California, USA.
Neurogastroenterol Motil. 2025 May 20:e70085. doi: 10.1111/nmo.70085.
In normal subjects, the esophagus and crus of the diaphragm slide relative to each other during esophageal peristalsis, which is not the case in patients with achalasia esophagus.
To examine the tissue characteristics of the esophageal hiatus in patients with achalasia esophagus, high amplitude esophageal contractions (HAEC), esophagogastric junction outflow obstruction (EGJOO), and normal subjects using radiomics analysis of the CT images.
A large number of medical records (1221 controls, 409 achalasia, 562 EGJOO, and 349 HAEC) were screened to identify subjects with a CT scan of the abdomen/chest in their record that met the pre-determined criteria. Using multiplanar rotation of CT images, the esophageal hiatus was visualized in a 2D plane. The grayscale intensity distributions (GSID) of the three regions of interest, i.e., (1) subcutaneous adipose tissue, (2) a posterior spine muscle (marker of fibro-connective tissue), and (3) esophageal hiatus were determined.
No differences in the mean GSID of subcutaneous adipose tissue and muscle were found among the four groups. On the other hand, the esophageal hiatus mean GSID was significantly higher in the three patient groups compared to controls. The GSIDs were higher in achalasia patients than in HAEC and EGJOO patients. The mean GSI of the hiatus was closer to that of the muscle with greater overlap between the hiatus and muscle in the three patient groups; the overlap was greater in achalasia as compared to HAEC and EGJOO patients.
A higher GSI of the hiatus with greater overlap between the hiatus and muscle suggests an increase in fibro-connective tissue in the esophageal hiatus of patients with primary esophageal motility disorders (EMD). We propose that fibrosis in the esophageal hiatus restricts axial separation between the LES and crural diaphragm, which may be important in the pathogenesis of esophageal motor disorders.
在正常受试者中，食管蠕动期间食管与膈脚会相对滑动，而贲门失弛缓症患者则不然。
利用CT图像的放射组学分析，检查贲门失弛缓症患者、高振幅食管收缩（HAEC）患者、食管胃交界流出道梗阻（EGJOO）患者以及正常受试者食管裂孔的组织特征。
筛选大量病历（1221名对照者、409名贲门失弛缓症患者、562名EGJOO患者和349名HAEC患者），以确定记录中有符合预定标准的腹部/胸部CT扫描的受试者。通过CT图像的多平面旋转，在二维平面上观察食管裂孔。确定三个感兴趣区域的灰度强度分布（GSID），即（1）皮下脂肪组织、（2）后脊柱肌肉（纤维结缔组织标志物）和（3）食管裂孔。
四组之间皮下脂肪组织和肌肉的平均GSID没有差异。另一方面，与对照组相比，三个患者组的食管裂孔平均GSID显著更高。贲门失弛缓症患者的GSID高于HAEC和EGJOO患者。三个患者组中裂孔的平均GSI更接近肌肉，裂孔与肌肉之间的重叠更大；与HAEC和EGJOO患者相比，贲门失弛缓症患者的重叠更大。
裂孔的GSI较高且裂孔与肌肉之间的重叠更大，表明原发性食管动力障碍（EMD）患者食管裂孔中的纤维结缔组织增加。我们认为食管裂孔中的纤维化限制了LES与膈脚之间的轴向分离，这可能在食管运动障碍的发病机制中起重要作用。
