Johnston P W, Johnston B T, Collins B J, Collins J S, Love A H
Department of Medicine, Royal Victoria Hospital, Belfast.
Gut. 1993 Sep;34(9):1158-61. doi: 10.1136/gut.34.9.1158.
This oesophageal laboratory serves a population of 1.5 million. The study aimed to review referral patterns and assess the cost effectiveness of oesophageal manometry in clinical practice. All 276 consecutive manometry studies performed between 1988 and 1991 were reviewed. Reasons for referral in the 268 first referrals were: dysphagia 50.4%, non-cardiac chest pain 23.1%, gastro-oesophageal reflux disease 14.2%, connective tissue disease 11.2%, and 'other' 1.1%. Manometry was normal in 49.3%, showed achalasia in 17.9%, diffuse oesophageal spasm in 13.4%, connective tissue disease in 7.8%, hypertensive lower oesophageal sphincter in 4.5%, nutcracker oesophagus in 2.6%, and 'other' in 4.5%. A positive diagnosis was significantly more common if dysphagia was the reason for referral (65.9% v 35.3%, p < 0.01). A positive diagnosis was established in 60% of patients referred with connective tissue disease, 30.6% with non-cardiac chest pain, and 21.1% with gastro-oesophageal reflux disease. A positive diagnosis was significantly more common in connective tissue disease when symptoms were present (85% v 10%, p < 0.05). Management was changed in 48.9% of all patients because of manometry findings. The cost of each oesophageal manometry study was calculated to be 63.00 pounds: every change in patient management cost 129.00 pounds. In conclusion, oesophageal manometry changed management in over 20% of patients with non-cardiac chest pain or gastro-oesophageal reflux disease and in over 60% of those with dysphagia. It is, therefore, a useful and cost effective test in patients with these symptoms.
这家食管实验室服务于150万人口。该研究旨在回顾转诊模式并评估食管测压在临床实践中的成本效益。回顾了1988年至1991年间连续进行的所有276项测压研究。268例首次转诊患者的转诊原因如下：吞咽困难占50.4%，非心源性胸痛占23.1%，胃食管反流病占14.2%，结缔组织病占11.2%，“其他”占1.1%。测压结果正常的占49.3%，显示贲门失弛缓症的占17.9%，弥漫性食管痉挛的占13.4%，结缔组织病的占7.8%，食管下括约肌高压的占4.5%，胡桃夹食管的占2.6%，“其他”的占4.5%。如果以吞咽困难作为转诊原因，阳性诊断显著更常见（65.9%对35.3%，p<0.01）。结缔组织病转诊患者中60%确诊，非心源性胸痛转诊患者中30.6%确诊，胃食管反流病转诊患者中21.1%确诊。结缔组织病患者出现症状时阳性诊断显著更常见（85%对10%，p<0.05）。由于测压结果，所有患者中有48.9%的治疗方案发生了改变。每项食管测压研究的成本计算为63.00英镑：患者治疗方案的每次改变花费129.00英镑。总之，食管测压改变了超过20%的非心源性胸痛或胃食管反流病患者以及超过60%的吞咽困难患者的治疗方案。因此，对于有这些症状的患者，它是一项有用且具有成本效益的检查。
