Stein H J, DeMeester T R
Department of Surgery, University of Southern California School of Medicine, Los Angeles 90033-4612.
Ann Surg. 1993 Feb;217(2):128-37. doi: 10.1097/00000658-199302000-00006.
The development of miniaturized electronic pressure transducers and portable digital data recorders with large storage capacity has made ambulatory monitoring of esophageal motor function over an entire circadian cycle possible. The broad clinical application of this new technology in a large number of asymptomatic normal volunteers and patients with primary esophageal motor disorders or gastroesophageal reflux disease provides new insights into esophageal motor function in health and disease under a variety of physiologic conditions. In normal volunteers and symptomatic patients, esophageal motor activity increases with both the state of consciousness and eating activity, i.e., from sleep to awake to meal periods. In the normal situation there is a higher prevalence of nonperistaltic esophageal contractions than appreciated on stationary manometry. Compared with standard manometry, ambulatory esophageal manometry provides a more than 100-fold larger database for the classification and quantitation of abnormal esophageal motor function and leads to a change in the diagnosis in a substantial portion of patients with symptoms suggestive of a primary esophageal motor disorder. In patients with nonobstructive dysphagia, the circadian esophageal motility pattern is characterized by an inability to organize the motor activity into peristaltic contractions during meal periods. In patients with noncardiac chest pain, ambulatory motility monitoring can document a direct correlation of abnormal esophageal motor activity with the symptom and shows that the abnormal motor activity immediately preceding the pain episodes is characterized by an increased frequency of simultaneous, double- and triple-peaked, high-amplitude, and long-duration contractions. A long esophageal myotomy can abolish the ability of the esophagus to produce this abnormal motor pattern. In patients with gastroesophageal reflux disease, ambulatory motility monitoring shows that the contractility of the esophageal body deteriorates with increasing severity of esophageal mucosal injury, compromising the clearance function of the esophageal body. These data suggest that ambulatory esophageal motility monitoring allows for a more precise classification of esophageal motor disorders than standard manometry and can identify abnormal esophageal motor pattern associated with nonobstructive dysphagia, noncardiac chest pain, or gastroesophageal reflux. Ambulatory esophageal manometry therefore should replace standard manometry in the assessment of esophageal body function and has potential to improve the diagnosis and management of patients with esophageal motor abnormalities. The combination of ambulatory 24-hour esophageal manometry with esophageal and gastric pH monitoring is currently the most physiologic way to assess patients with functional foregut disorders.
小型电子压力传感器和大容量便携式数字数据记录仪的发展，使得在整个昼夜周期内动态监测食管运动功能成为可能。这项新技术在大量无症状正常志愿者以及患有原发性食管运动障碍或胃食管反流病的患者中的广泛临床应用，为在各种生理条件下健康和患病状态下的食管运动功能提供了新的见解。在正常志愿者和有症状的患者中，食管运动活动随意识状态和进食活动而增加，即从睡眠到清醒再到用餐时段。在正常情况下，非蠕动性食管收缩的发生率比静态测压法所认识到的更高。与标准测压法相比，动态食管测压法为异常食管运动功能的分类和定量提供了一个比其大100多倍的数据库，并导致相当一部分提示原发性食管运动障碍症状的患者的诊断发生改变。在非梗阻性吞咽困难患者中，昼夜食管动力模式的特征是在进餐时段无法将运动活动组织成蠕动性收缩。在非心源性胸痛患者中，动态动力监测可以记录异常食管运动活动与症状之间的直接相关性，并表明疼痛发作前立即出现的异常运动活动的特征是同时出现、双峰和三峰、高幅度和持续时间长的收缩频率增加。长段食管肌切开术可以消除食管产生这种异常运动模式的能力。在胃食管反流病患者中，动态动力监测表明，随着食管黏膜损伤严重程度的增加，食管体部的收缩能力会恶化，从而损害食管体部的清除功能。这些数据表明，与标准测压法相比，动态食管动力监测能够对食管运动障碍进行更精确的分类，并能够识别与非梗阻性吞咽困难、非心源性胸痛或胃食管反流相关的异常食管运动模式。因此，在评估食管体部功能时，动态食管测压法应取代标准测压法，并且有可能改善食管运动异常患者的诊断和管理。24小时动态食管测压法与食管和胃pH监测相结合，目前是评估功能性前肠疾病患者的最符合生理的方法。
