Esophageal diverticula are associated with propagating peristalsis: a study utilizing high-resolution manometry.
Esophageal diverticula are associated with propagating peristalsis: a study utilizing high-resolution manometry.
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DOI：
10.1111/nmo.12739
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发表时间：
2016-03
影响因子：
3.5
通讯作者：
Pandolfino JE
中科院分区：
文献类型：
--
作者：
Carlson DA;Gluskin AB;Mogni B;Koo J;Sood R;Lin Z;Pandolfino JE
食管憩室与食管动力障碍有关，最常见的是贲门失弛缓症。我们的目的是评估高分辨率测压（HRM）的运动诊断和加压模式与食管憩室患者。回顾性识别患者的远端食管憩室和既往完成的HRM。根据芝加哥分类法分析HRM，并测量食管推注传输的区室化阶段（上食管括约肌闭合和过渡区之间的时间）的压力斜率。还测量了10名无症状志愿者（对照组）的压力斜率以进行比较。纳入19例患者（年龄31 - 83岁）。8例（42%）患者动力正常，5例（26%）食管胃连接部流出道梗阻，2例（11%）手提钻食管; 4例患者有其他动力诊断，包括仅1例贲门失弛缓症患者。共有6例患者（32%）至少发生1次吞咽过度收缩。在仰卧位和仰卧位的食管中段观察到更大的间隔化阶段压力斜率[中位数（IQR）：1.9 mmHg/s（0.9，3.6）]和直立[1.1（0.1，3.1）]位置比对照组[仰卧：-1.3（-2.4，-0.11），p = 0.001;直立：-0.71（-2.1，-0.02），p = 0.005）。在我们的食管憩室患者队列中，常伴有收缩功能亢进的扩张性食管狭窄是常见的。异常室隔化阶段加压可能表明异常食管壁力学和/或顺应性与憩室的关系;然而，这些发现是因果关系还是反应性尚不清楚。
Esophageal diverticula have been associated with esophageal motility disorders, most commonly achalasia. We aimed to evaluate high-resolution manometry (HRM) motility diagnoses and pressurization patterns in patients with esophageal diverticula. Patients were retrospectively identified for distal esophageal diverticula and previously completed HRM. HRMs were analyzed according to the Chicago Classification and the pressure slope of the compartmentalization phase (time between upper esophageal sphincter closure and the transition zone) of esophageal bolus transit was measured. Pressure slopes were also measured in 10 asymptomatic volunteers (controls) for comparison. 19 patients (ages 31 – 83) were included. 8 (42%) patients had normal motility, 5 (26%) had esophagogastric junction outflow obstruction, and 2 (11%) had jackhammer esophagus; 4 patients had other motility diagnoses including only one patient with achalasia. A total of 6 patients (32%) had at least one hypercontractile swallow. Greater compartmentalization phase pressure slopes were observed in patients at the mid-esophageal body in both supine [median (IQR): 1.9 mmHg/s (0.9, 3.6)] and upright [1.1 (0.1, 3.1)] positions than in controls [supine: −1.3 (−2.4, −0.11), p = 0.001; upright; −0.71 (−2.1, −0.02), p = 0.005). Propagating peristalsis, often with hypercontractility, was commonly seen in our cohort of patients with esophageal diverticula. Abnormal compartmentalization phase pressurization may indicate a relationship of abnormal esophageal wall mechanics and/or compliance with diverticula; however whether these findings are causal or reactionary remains unclear.