Esophageal High-Resolution Manometry for Diagnosing the Severity of the Chronic Intestinal Pseudo-Obstruction: A Case Series
Esophageal High-Resolution Manometry for Diagnosing the Severity of the Chronic Intestinal Pseudo-Obstruction: A Case Series
复制标题
DOI：
10.1007/s10620-020-06701-9
复制
发表时间：
2020-11-12
影响因子：
3.1
通讯作者：
Terai, Shuji
中科院分区：
文献类型：
--
作者：
Sato, Hiroki;Kamimura, Kenya;Terai, Shuji
背景慢性肠假性梗阻(CIPO)是一种严重的难治性肠动力障碍。然而，由于它的罕见和组织学研究的困难，其病理生理学尚未被描述。目的：本研究旨在探讨食道高分辨率测压(HRM)在慢性阻塞性肺疾病(CIPO)中的作用以及该病的组织学和临床特点。方法分析CIPO患者的临床特点、组织学表现及治疗干预后的临床病程。此外，还进行了HRM检查以确定是否有食道受累。结果11例确诊为CIPO，5例需要长期肠外营养，HRM诊断为食道动力异常，包括失弛缓症和无收缩功能。这五个病例中的四个在妊娠、阑尾炎和手术的触发事件之后表现出急性CIPO。相比之下，HRM上其他6例食道正常或杰克哈默尔食道的患者均为中度CIPO，且逐渐发病。组织学分析表明，炎症、破坏和萎缩引起的肠神经节细胞和神经节细胞层的丢失与疾病的严重程度和食道的HRM表现有关，表现为失弛缓症和无收缩。结论HRM可用于诊断CIPO的临床病程严重程度和确定治疗方案。
Background Chronic intestinal pseudo-obstruction (CIPO) is a severe and refractory intestinal motility disorder. However, due to its rarity and difficult histological investigation, its pathophysiology has not been characterized. Aim Therefore, in this study, we aimed to determine the role of esophageal high-resolution manometry (HRM) in CIPO and the histological and clinical characteristics of the disease. Methods Patients with CIPO were analyzed for clinical characteristics; histological findings; and clinical courses after therapeutic intervention. In addition, HRM was performed to determine the esophageal involvement. Results Eleven patients were diagnosed with CIPO, and five required the long period of parenteral nutrition showing impaired esophageal motility including achalasia and absent contractility diagnosed with HRM. The four of these five cases showed acute onset of the CIPO following the triggering events of pregnancy, appendicitis, and surgery. In contrast, other six patients with normal or Jackhammer esophagus on HRM had moderate severity of CIPO with gradual onset. The histological analyses revealed that the loss of the intestinal neural ganglion cells and layers by inflammation, destruction, and atrophy are related to the severity of the clinical course of the disease and esophageal HRM findings of achalasia and absent contractility. Conclusions HRM may be useful to diagnose the severity of the clinical course and to determine the therapeutic options for CIPO.