Clinical relevance of the nutcracker esophagus: Suggested revision of criteria for diagnosis
Clinical relevance of the nutcracker esophagus: Suggested revision of criteria for diagnosis
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DOI：
10.1097/00004836-200607000-00008
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发表时间：
2006-07-01
影响因子：
2.9
通讯作者：
Castell, Donald O.
中科院分区：
文献类型：
--
作者：
Agrawal, Amit;Hila, Amine;Castell, Donald O.
背景：胡桃夹型食道(NE)是一种以食道远端平均收缩幅度(DEA)和180毫米汞柱的蠕动收缩为特征的测压发现。之所以选择这个阈值，是因为它比健康志愿者的平均DEA高出2个标准差。自从它被提出以来，这一发现的临床意义一直受到挑战，因为许多NE患者没有症状。目的：评估基于不同的DEA阈值定义NE是否在临床上更有意义。方法：回顾2001年10月至2003年12月前瞻性收集的测压数据。使用以前发表的正常DEA值(平均值和SD)，NE患者被分成3组：A组(高于平均值2-3 SD)：DEA 180-220 mm Hg；B组(3-4 SD，高于平均值)：DEA 220-260 mm Hg；和C组(>；4 SD高于平均值)：DEA>；260 mm Hg。结果：56例NE患者分为A组31例，B组16例，C组9例。出现胸痛的患者比例从A组的23%增加到B组的69%和C组的100%。C组患者的平均下食道括约肌压力显著更高(P<；0.05)，团注通过时间更短，异常反流的频率更低。结论：修订的NE定义包括DEA>；260 mm Hg的患者，可能还有>；220的患者可能具有更大的临床相关性。
Background: Nutcracker esophagus (NE) is a manometric finding defined by peristaltic contractions with a mean distal esophageal amplitude (DEA) > 180 mm Hg. This threshold has been selected as it exceeds the average DEA in healthy volunteers by 2 SDs. Since its introduction the clinical significance of this finding has been challenged, as many patients with NE are asymptomatic. Aim: To evaluate whether defining NE based on a different DEA threshold would be clinically more meaningful.Methods: Retrospective review of prospectively collected manometry data between October 2001 and December 2003. Using previously published normal DEA values (mean and SD) patients with NE were stratified into 3 groups: group A (2 to 3 SD above mean): DEA 180 to 220 mm Hg; group B (3 to 4 SD above mean): DEA 220 to 260 mm Hg; and group C (> 4 SD above mean): DEA > 260 mm Hg. Symptoms, esophageal acid exposure, bolus transit data, and lower esophageal sphincter data were reviewed.Results: The stratification of 56 NE patients into groups A, B, and C were 31, 16, and 9, respectively. The proportion of patients presenting with chest pain increased from 23% in group A to 69% in group B and 100% in group C. Patients in group C had significantly (P < 0.05) higher mean lower esophageal sphincter pressure, shorter bolus transit time, and lower frequency of abnormal reflux.Conclusions: A revised definition of NE to include patients with a DEA > 260 mm Hg, and possibly those with > 220 may have greater clinical relevance.