The contractile deceleration point: an important physiologic landmark on oesophageal pressure topography
The contractile deceleration point: an important physiologic landmark on oesophageal pressure topography
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DOI：
10.1111/j.1365-2982.2009.01443.x
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发表时间：
2010-04-01
影响因子：
3.5
通讯作者：
Kahrilas, P. J.
中科院分区：
文献类型：
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作者：
Pandolfino, J. E.;Leslie, E.;Kahrilas, P. J.
本研究旨在将食管团的传输与食道压力地形图(OPT)的特征相关联，并建立准确测量蠕动速度的OPT指标。OPT图中的吞咽收缩前沿速度(CFV)被用户定义的减速点(CDP)细分为初始快相(CFV(快速))和随后的慢相(CFV(慢))。分析从最初的快速扩张的伴有蠕动的管腔关闭到缓慢的壶腹排空的团注清除特征的荧光透视研究，并确定关闭前沿和间歇期的压力传感器。食道压力地形图测量与团注传输的透视里程碑相关。通过对68例受试者的食道压力地形图研究，建立了食道血流速度(快、慢)的正常范围。结果36只燕子均可测到明显的收缩速度变化，快收缩段和慢收缩段的平均速度分别为4.2 cm S-1和1.0 cm S-1。OPT上记录的CDP与膈壶腹部的形成密切相关，使CFV(快)(平均5.1 cm S-1)与壶腹蠕动传播密切相关，CFV(慢)(平均1.7 cm S-1)与壶腹排空密切相关。结论与推断OPT图上CFV的减速点准确地将反映蠕动速度(CFV(快))的早期区域与反映壶腹部排空进程(CFV(慢))的晚期区域(CFV(慢))区分开来。这些区别应该有助于客观化蠕动障碍的定义，特别是痉挛，并提高对跨越食道胃交界处的团注传输受损的理解。
BackgroundThis study aimed to correlate oesophageal bolus transit with features of oesophageal pressure topography (OPT) plots and establish OPT metrics for accurately measuring peristaltic velocity.MethodsAbout 18 subjects underwent concurrent OPT and fluoroscopy studies. The deglutitive Contractile Front Velocity (CFV) in OPT plots was subdivided into an initial fast phase (CFV(fast)) and subsequent slow phase (CFV(slow)) separated by a user-defined deceleration point (CDP). Fluoroscopy studies were analyzed for the transition from the initial rapidly propagated luminal closure associated with peristalsis to slow bolus clearance characteristic of phrenic ampullary emptying and to identify the pressure sensors at the closure front and at the hiatus. Oesophageal pressure topography measures were correlated with fluoroscopic milestones of bolus transit. Oesophageal pressure topography studies from another 68 volunteers were utilized to develop normative ranges for CFV(fast) and CFV(slow).Key ResultsA distinct change in velocity could be determined in all 36 barium swallows with the fast and slow contractile segments having a median velocity of 4.2 cm s-1 and 1.0 cm s-1, respectively. The CDP noted on OPT correlated closely with formation of the phrenic ampulla making CFV(fast) (mean 5.1 cm s-1) correspond closely to peristaltic propagation and CFV(slow) (mean 1.7 cm s-1) to ampullary emptying.Conclusions & InferencesThe deceleration point in the CFV on OPT plots accurately demarcated the early region in which the CFV reflects peristaltic velocity (CFV(fast)) from the later region where it reflects the progression of ampullary emptying (CFV(slow)). These distinctions should help objectify definitions of disordered peristalsis, especially spasm, and improve understanding of impaired bolus transit across the oesophagogastric junction.