Comprehensive characterization of antral and pyloric contractions by high resolution manometry: applied physiology in suspected gastroparesis.
Comprehensive characterization of antral and pyloric contractions by high resolution manometry: applied physiology in suspected gastroparesis.
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通过高分辨率测压法全面表征胃窦和幽门收缩：疑似胃轻瘫的应用生理学。
DOI：
10.1152/ajpgi.00119.2022
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发表时间：
2022
期刊：
影响因子：
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通讯作者：
Camilleri,Michael
中科院分区：
文献类型：
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作者：
Zheng,Ting;BouSaba,Joelle;Sannaa,Wassel;Eckert,DeborahJ;Burton,DuaneD;Camilleri,Michael
胃排空延迟可由多种病理生理机制引起，包括胃窦动力减退和幽门痉挛。随着胃镜下肌切开术的日益广泛应用和疗效的初步证实，我们的目的是用高分辨率胃窦十二指肠测压技术(HR-ADM)评估胃轻瘫患者远端胃窦和幽门的运动功能。对16例有胃瘫症状的患者行HR-ADM检查，其中13个传感器位于十二指肠降段和十二指肠远端，间隔1 cm，放置在十二指肠降段和十二指肠远端，间隔1 cm。餐后1h的运动以收缩频率/分钟、平均波幅和运动指数(MI)为指标进行量化。6名健康志愿者作为对照。在患者组中，HR-ADM发现餐后胃窦动力减退，孤立的幽门压力波，以及幽门基线压力的紧张性升高。与健康志愿者相比，患者每分钟餐后1小时胃窦收缩频率显著减少[1.52(0.97，1.67)比2.04(1.7，2.67，P=0.005)]，MI也降低[9.65(8.29，10.31)比11.04(10.65，11.63)，P=0.002]。平均收缩幅度在数值上有所降低[51.9(21.9，74.9)vs 73.0(59.8，82.7)，P=0.14]。Bland-Altman曲线图显示，在第一和第二个餐后30分钟期间，患者和对照组的胃窦收缩频率和MI的分布相似。高分辨率ADM可以表征各种餐后胃窦收缩和幽门运动功能障碍。这项技术有望为胃轻瘫患者选择最佳治疗方法提供指导。目前，胃轻瘫患者的不同治疗方法的选择是经验性的或基于反复试验，尽管幽门的扩张性和直径可能预测幽门干预的反应。高分辨率胃窦或十二指肠测压(HR-ADM)可以表征疑似胃瘫患者的各种餐后胃窦收缩和幽门运动功能障碍。HR-ADM有望根据记录的病理生理学为胃轻瘫患者提供选择和个体化治疗的指导，如促动力药物或幽门干预。
Delayed gastric emptying may result from diverse pathophysiological mechanisms including antral hypomotility and pylorospasm. With increasing use of gastric peroral endoscopic myotomy and preliminary evidence of efficacy, our aim was to assess the motor functions of the distal antrum and pylorus in patients with symptoms of gastroparesis using high-resolution antropyloroduodenal manometry (HR-ADM). Sixteen patients with symptoms suggestive of gastroparesis underwent HR-ADM with 13 sensors, 1 cm apart, placed across the antropyloroduodenal (APD) junction and 2 sensors, 10 cm apart, in descending and distal duodenum. The 1-h postprandial motility was quantitated as contraction frequency/minute, average amplitude, and motility index (MI). Six healthy volunteers served as controls. In the patient group, the HR-ADM identified postprandial antral hypomotility, isolated pyloric pressure waves, and tonic elevation of baseline pressure in pylorus. Patients had significantly reduced frequency of the full-hour postprandial antral contractions/minute compared with healthy volunteers [1.52 (0.97, 1.67) vs. 2.04 (1.70, 2.67),P= 0.005], as well as reduced MI [9.65 (8.29, 10.31) vs. 11.04 (10.65, 11.63),P= 0.002]. The average contraction amplitude was numerically, but not significantly reduced [51.9 (21.9, 74.9) vs. 73.0 (59.8, 82.7),P= 0.14]. Bland–Altman plots showed similar distribution of antral contraction frequency and MI during the first and second postprandial 30-min periods for both patients and controls. High-resolution ADM can characterize a variety of postprandial antral contractile and pyloric motility dysfunctions. This technique shows promise to provide guidance for the selection of optimal treatment of patients with gastroparesis.NEW & NOTEWORTHYCurrent selection of different treatments for patients with gastroparesis is empiric or based on trial and error, though pyloric distensibility and diameter may predict response to pyloric interventions. High-resolution antropyloroduodenal manometry (HR-ADM) can characterize a variety of postprandial antral contractile and pyloric motility dysfunctions in patients with suspected gastroparesis. HR-ADM shows promise to provide guidance for selection and individualization of treatments such as prokinetic agents or pyloric interventions for patients with gastroparesis based on documented pathophysiology.