High-resolution manometry combined with impedance measurements discriminates the cause of dysphagia in children
High-resolution manometry combined with impedance measurements discriminates the cause of dysphagia in children
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DOI：
10.1007/s00431-015-2582-9
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发表时间：
2015-12-01
影响因子：
3.6
通讯作者：
Nurko, Samuel
中科院分区：
文献类型：
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作者：
Rommel, Nathalie;Omari, Taher I.;Nurko, Samuel
压力流量分析可以评估食管食团输送与食管压力的关系。本研究旨在表征与儿科患者吞咽困难相关的压力流量指标。我们分析了 35 名儿童（17 M，平均 10.5 +/- 0.8 岁）吞咽 5 毫升液体和粘性液体的食管压力阻抗记录。转诊的主要适应症是胃食管反流病（GERD）（9）、胃底折叠术后吞咽困难（5）、特发性吞咽困难（16）、气管食管瘘（2）和其他（3）。使用 20 mmHg 等轮廓缺陷评估蠕动功能，并使用压力流量指数（与吞咽困难相关的升高指标）评估推注压力和流量之间的时间。根据吞咽困难和蠕动缺陷大小对患者进行分层。吞咽困难的特点是液体蠕动较弱，粘性液体压力流量指数较高。当根据蠕动弱或正常对患者进行分层时，蠕动弱的吞咽困难与较大的等轮廓缺损尺寸相关，而蠕动正常的吞咽困难与较高的压力流量指数相关。结论：压力流量分析能够区分因蠕动弱（食团清除差）导致的吞咽困难患者与异常的食团流量阻力（食管流出阻塞）。这种新的食管功能二分法分类可能有助于指导最佳治疗方法的选择，例如药物或内窥镜治疗。
Pressure-flow analysis allows assessing esophageal bolus transport in relation to esophageal pressures. This study aimed to characterize pressure-flow metrics in relation to dysphagia in paediatric patients. We analysed esophageal pressure-impedance recordings of 5 ml liquid and viscous swallows from 35 children (17 M, mean 10.5 +/- 0.8 years). Primary indication for referral was gastroesophageal reflux disease (GERD) (9), post-fundoplication dysphagia (5), idiopathic dysphagia (16), trachea-esophageal fistula (2) and other (3). Peristaltic function was assessed using the 20 mmHg iso-contour defect and the timing between bolus pressure and flow was assessed using the Pressure Flow Index, a metric elevated in relation to dysphagia. Patients were stratified in relation to dysphagia and to peristaltic defect size. Dysphagia was characterized by a weaker peristalsis for liquids and higher Pressure Flow Index for viscous. When patients were stratified based on weak or normal peristalsis, dysphagia with weak peristalsis related to a larger iso-contour defect size and dysphagia with normal peristalsis related to higher Pressure Flow Index.Conclusion: Pressure-flow analysis enables differentiation of patients with dysphagia due to weak peristalsis (poor bolus clearance) from abnormal bolus flow resistance (esophageal outflow obstruction). This new dichotomous categorization of esophageal function may help guide the selection of optimal treatment such as pharmacological or endoscopic therapy.