高收缩性食管：临床表现、激发试验在高分辨率测压中的作用及长期预后——来自亚洲队列的结果

Hypercontractile Esophagus: Clinical Presentation, Role of Provocative Tests in High Resolution Manometry and Long Term Outcome-Results From an Asian Cohort.

作者信息

Ang Daphne, Koo Seok-Hwee, Hong Wallace Bok-Thoe, Kuang Jonathan Zi-Yang, Tan Andrew Xia-Huang

机构信息

Department of Gastroenterology, Changi General Hospital, Singapore, Singapore.

Clinical Trials and Research Unit, Changi General Hospital, Singapore, Singapore.

出版信息

Neurogastroenterol Motil. 2025 Jul 23:e70129. doi: 10.1111/nmo.70129.

DOI:10.1111/nmo.70129

PMID:40698610

Abstract

BACKGROUND

Hypercontractile esophagus (HE) is rare. Esophageal high-resolution manometry (HRM) with solid test meal (STM) in Chicago Classification (CCv4.0) may improve diagnostic yield, but outcome data are lacking.

AIM

Evaluate the clinical features and long-term outcome of HE, and determine the clinical significance of hypercontractility detected only using STM.

METHODS

Single-center analysis of all patients with ≥ 2 hypercontractile swallows (HS) (distal contractile integral [DCI] > 8000 mmHg.s.cm) on HRM studies with single water swallows (SWS) and/or STM between June 2014 and December 2021. A telephone survey was conducted between January and June 2023 using Impaction Dysphagia Questionnaire [IDQ], Eckardt scores, and the Gastro-Esophageal Reflux Disease Questionnaire (GERD-Q) to determine long-term outcomes.

RESULTS

Forty-eight patients (29 [60.4%] Female, 63.0 [13.4] years) with HS who presented with dysphagia (60%), reflux (37.5%) and chest pain (29.2%) and 58 controls (28 [48.3%] Female, 49 [13.4] years) with dysphagia (n = 43.1%), reflux (n = 41.4%) and chest pain (15.5%) with normal HRM findings were identified from 454 studies performed. More patients had HS with STM versus SWS (n = 41 [85.4%] vs. n = 7 [14.6%], p < 0.001). Dysphagia was significantly associated with mean DCI (B = 0.000, p = 0.035) and maximal DCI (B = 0.000, p = 0.036) during STM. 43% (n = 3/7) and 22% (n = 9/41) of patients with ≥ 2 HS using SWS and STM respectively were on medical therapy at mean (SD) clinic follow-up of 28.7 (29.2) months. At mean (SD) follow-up telephone survey of 61.3 (27.1) months from HRM, symptom scores amongst 36/48 (75%) patients and 58 controls were: IDQ (3.8 [0-4] vs. 1.0 [0-1.3], p = 0.03); Eckardt dysphagia score (0.46 [0.0-1.0] vs. 0.14 [0-0], p = 0.007); GerdQ (6.4 [6.0-6.0] vs. 7.0 [6.0-8.0], pNS) respectively.

CONCLUSIONS

STM enhanced diagnostic yield of HS and identified more patients who benefitted from medical therapy.

摘要

背景

高收缩性食管（HE）较为罕见。采用芝加哥分类法（CCv4.0）的固体试餐（STM）进行食管高分辨率测压（HRM）可能会提高诊断率，但缺乏相关结局数据。

目的

评估HE的临床特征和长期结局，并确定仅通过STM检测到的高收缩性的临床意义。

方法

对2014年6月至2021年12月期间接受单水吞咽（SWS）和/或STM的HRM研究中所有有≥2次高收缩性吞咽（HS）（远端收缩积分[DCI]＞8000mmHg·s·cm）的患者进行单中心分析。2023年1月至6月期间进行了一项电话调查，使用吞咽困难问卷[IDQ]、埃卡德特评分和胃食管反流病问卷（GERD-Q）来确定长期结局。

结果

从454项研究中确定了48例有HS的患者（29例[60.4%]为女性，年龄63.0[13.4]岁），这些患者出现吞咽困难（60%）、反流（37.5%）和胸痛（29.2%），以及58例对照患者（28例[48.3%]为女性，年龄49[13.4]岁），这些对照患者有吞咽困难（n = 43.1%）、反流（n = 41.4%）和胸痛（15.5%），HRM结果正常。与SWS相比，有更多患者通过STM检测到HS（n = 41[85.4%]对n = 7[14.6%]，p＜0.001）。在STM期间，吞咽困难与平均DCI（B = 0.000，p = 0.035）和最大DCI（B = 0.000，p = 0.036）显著相关。在平均（标准差）28.7（29.2）个月的门诊随访中，分别有43%（n = 3/7）和22%（n = 9/41）使用SWS和STM且有≥2次HS的患者正在接受药物治疗。在HRM后平均（标准差）61.3（27.1）个月的随访电话调查中，36/48（75%）例患者和58例对照患者之间的症状评分如下：IDQ（3.8[0 - 4]对1.0[0 - 1.3]，p = 0.03）；埃卡德特吞咽困难评分（0.46[0.0 - 1.0]对0.14[0 - 0]，p = 0.007）；GerdQ（6.4[6.0 - 6.0]对7.0[6.0 - 8.0]，p无统计学意义）。