Manometry and impedance characteristics of achalasia. Facts and myths
Manometry and impedance characteristics of achalasia. Facts and myths
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DOI：
10.1097/01.mcg.0000248013.78020.b4
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发表时间：
2008-03-01
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：贲门失弛缓症是由食管非蠕动来定义的。失弛缓症患者的压力测量结果存在差异，提示诊断失弛缓症不需要所有的压力测量特征。联合多通道腔内阻抗和食管压力测量（MII-EM）可以对食管运动进行功能和压力测量评估，并识别慢性液体潴留。目的：比较贲门失弛缓症患者的血压和MII特征。方法：回顾性分析2001年10月至2004年12月在我们实验室进行的73例失弛缓症患者的MII-EM追踪（38例女性，平均年龄= 53.5 y）。排除既往食管干预的患者。对10只液体燕子和10只粘性燕子的压力测量和MII特征进行了鉴定和比较。患者也分为两组：健全性失弛缓症（VA）和失弛缓症（achalasia）。结果：71例贲门失弛缓症患者中有22例（31%）存在高血压性食管下括约肌（LES）。71例贲门失弛缓症患者平均食管下括约肌压（LESP）为37.9 +/- 21.2mm Hg， 73例运动正常患者为27.3 +/- 9.3 mm Hg （P < 0.05）。贲门失弛缓症患者的平均LESP为36 +/- 20.3 mm Hg， VA患者的平均LESP为47 +/- 23.2 min Hg (P < 0.05)，食管内压（lEP）升高的患者为45/73（61.6%）。正常IEP组LESP平均值为41.1 +/- 22.9 mm Hg，而正常IEP组为32.5 +/- 17 mm Hg （P < 0.05）。贲门失弛缓症的平均基线阻抗为801 +/- 732，而VA患者的平均基线阻抗为1265.2 +/- 829.5 ω (P < 0.05)。结论：大多数贲门失弛缓症患者IEP升高，LES残余压升高，LES压正常，基线阻抗低。诊断失弛缓症不需要所有的压力测量特征。IEP升高的患者可能有LES压和LES残余压升高。低MII值可识别慢性液体潴留，有助于确诊。
Background: Achalasia is defined manometrically by an aperistaltic esophagus. Variations in the manometric findings occur in achalasia suggesting that all manometric features should not be required to diagnose achalasia. Combined multichannel intraluminal impedance and esophageal manometry (MII-EM) allows both a functional and a manometric evaluation of esophageal motility and identifies chronic fluid retention.Aim: To compare manometric and MII characteristics in patients with achalasia.Methods: Retrospective review of 73 MII-EM tracings from patients with achalasia done in our laboratory between October 2001 and December 2004 (38 females; mean age = 53.5 y). Patients with previous esophageal interventions were excluded. Manometric and MII characteristics were identified and compared during 10 liquid and 10 viscous swallows. Patients were also divided into 2 groups: vigorous achalasia (VA) and achalasia.Results: Twenty-two of the seventy-one (31 %) achalasia patients had a hypertensive lower esophageal sphincter (LES). The mean lower esophageal sphincter pressure (LESP) for the 71 patients with achalasia was 37.9 +/- 21.2mm Hg compared with 27.3 +/- 9.3 mm Hg (P < 0.05) in the 73 patients with normal motility. The mean LESP in patients with achalasia was 36 +/- 20.3 mm Hg compared with 47 +/- 23.2 min Hg (P < 0.05) in patients with VA. Elevated intraesophageal pressure (lEP) was noted in 45/73 (61.6%). The mean LESP in this group was 41.1 +/- 22.9 mm Hg compared with 32.5 +/- 17 mm Hg (P < 0.05) with normal IEP. The mean baseline impedance for achalasia was 801 +/- 732 compared with 1265.2 +/- 829.5 Omega (P < 0.05) for the VA patients.Conclusions: Most patients with achalasia have elevated IEP, elevated LES residual pressure, normal LES pressure, and low baseline impedance. All manometric features should not be required to diagnose achalasia. Patients with an elevated IEP are likely to have an elevated LES pressure and LES residual pressure. Low MII values identify chronic fluid retention and helps confirm the diagnosis.