Jackhammer esophagus: Observations on a European cohort
Jackhammer esophagus: Observations on a European cohort
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DOI：
10.1111/nmo.12975
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发表时间：
2017-04-01
影响因子：
3.5
通讯作者：
Bredenoord, A. J.
中科院分区：
文献类型：
--
作者：
Herregods, T. V. K.;Smout, A. J. P. M.;Bredenoord, A. J.
背景：随着高分辨率测压仪（HRM）的出现，一种新的诊断——手提锤式食管被引入。我们对这种罕见的疾病知之甚少，而且症状和过度收缩之间的关系并不总是直截了当的。我们研究的目的是描述一个大队列的风钻式食管患者，并调查压力测量结果是否与症状的存在有关。方法：分析2014年6月至2015年12月在两个三级中心就诊的所有至少有一例咽部超收缩（远端收缩积分[DCI] > 8000mmhg /s/cm）的HRM患者。排除有20%过早吞咽的患者，或有其他诊断解释其症状的患者。关键结果：在34例确定为钻锤式食管的患者中，大多数患有吞咽困难（67.6%）和/或胸痛（47.1%）。胸痛症状与任何压力测量结果无关，而吞咽困难与过度收缩燕子的DCI和肠内压力有关。此外，所有食管下括约肌（LES）区孤立性DCI低于2000 mm Hg/s/cm的患者均出现吞咽困难。基于收缩类型（单峰或多峰）或基于满足芝加哥分类v3.0和v2.0标准的亚组之间HRM和临床特征的差异有限。结论与推论：吞咽困难的症状伴随着LES的强烈收缩，可能有流出梗阻的迹象，DCI非常高。多峰收缩的存在似乎是有限的相关性，在标记患者有一个吞咽过度收缩为正常是有必要的。
Background: With the advent of high-resolution manometry (HRM), a new diagnosis, jackhammer esophagus, was introduced. Little is known about this rare condition, and the relationship between symptoms and hypercontractility is not always straightforward. The aim of our study was to describe a large cohort of patients with jackhammer esophagus and to investigate whether manometric findings are associated with the presence of symptoms.Methods: All patients from 06, 2014 until 12, 2015 seen at two tertiary centers with at least one hypercontractile swallow ( distal contractile integral [DCI] > 8000 mm Hg/s/cm) on HRM were analyzed. Patients with =20% premature swallows, or patients with another diagnosis explaining their symptoms were excluded.Key Results: Of the 34 patients identified with jackhammer esophagus, most suffered from dysphagia (67.6%) and/or chest pain (47.1%). The symptom chest pain was not associated with any of the manometric findings, whereas dysphagia was associated with the DCI of the hypercontractile swallows and with intrabolus pressure. In addition, all patients who had an isolated DCI of the lower esophageal sphincter (LES) zone > 2000 mm Hg/s/cm had dysphagia. The differences in HRM and clinical characteristics between subgroups based on the contraction type ( single- or multi-peaked) or based on meeting criteria of the Chicago Classification v3.0 and v2.0 were limited.Conclusions & Inferences: The symptom dysphagia is accompanied with strong contractions of the LES, signs of a possible outflow obstruction, and a very high DCI. The presence of a multipeaked contraction seems to be of limited relevance, and caution is warranted in labeling patients with one hypercontractile swallow as normal.