Asynchrony between the circular and the longitudinal muscle contraction in patients with nutcracker esophagus
Asynchrony between the circular and the longitudinal muscle contraction in patients with nutcracker esophagus
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DOI：
10.1053/j.gastro.2005.02.002
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发表时间：
2005-05-01
期刊：
影响因子：
29.4
通讯作者：
Mittal, RK
中科院分区：
文献类型：
--
作者：
Jung, HY;Puckett, JL;Mittal, RK
背景和目标：在食管收缩期间管腔内压力和肌肉横截面积（CSA）的增加是环形和纵向肌肉收缩的标志。本研究的目的是确定健康受试者和胡桃夹食管患者的环形和纵向肌肉收缩之间的时间同步性。研究方法：压力和高频腔内超声（HFIUS）图像同时记录在健康受试者和患者胡桃夹食管在2和10厘米以上的食管下括约肌湿吞咽。高频超声图像进行数字化和分析的肌肉CSA。确定峰值肌肉CSA和峰值压力之间的时间间隔（delta-t）。结果如下：在健康受试者中，峰值收缩压和峰值肌肉CSA之间存在密切的时间相关性，在2 cm和10 cm水平（0-0.5秒）处的最大Δ t为0.5秒。另一方面，患者组在2 cm水平的中位delta-t为1.25秒（0.75-3.5秒），在10 cm水平的中位delta-t为0.75秒（0-2.0秒）。在103例患者中，98例收缩的delta-t > 0.5秒。压力波振幅、压力波持续时间和峰值肌横截面积与delta-t有显著相关性。胡桃夹食管患者压力波持续时间较正常人延长，而CSA波持续时间无明显变化。结论：胡桃夹食管患者环肌层和纵肌层的收缩存在时间上的延迟。
Background & Aims: The increases in intraluminal pressure and muscle cross-sectional area (CSA) during esophageal contraction are markers of circular and longitudinal muscle contractions. The goal of our study was to determine temporal synchrony between circular and longitudinal muscle contraction in healthy subjects and patients with nutcracker esophagus. Methods: Pressure and high-frequency intraluminal ultrasound (HFIUS) images were recorded simultaneously in healthy subjects and patients with nutcracker esophagus at 2 and 10 cm above the lower esophageal sphincter during wet swallow. HFIUS images were digitized and analyzed for the muscle CSA. The time interval (delta-t) between the peak muscle CSA and the peak pressure was determined. Results: In healthy subjects, a close temporal correlation existed between the peak contraction pressure and the peak muscle CSA with a maximum delta-t of 0.5 seconds at the 2- and 10-cm levels (0-0.5 seconds). On the other hand, the patient group had a median delta-t of 1.25 seconds (0.75-3.5 seconds) at the 2-cm level and 0.75 seconds (0-2.0 seconds) at the 10-cm level. Ninety-eight of 103 contractions in patients showed a delta-t > 0.5 seconds. There was a significant correlation between delta-t and the amplitude of pressure wave, the duration of pressure wave, and the peak muscle CSA. The duration of pressure wave but not the duration of CSA wave was longer in patients with nutcracker esophagus as compared with healthy subjects. Conclusions: Patients with nutcracker esophagus show temporal asynchrony between the contractions of circular and longitudinal muscle layers.