New techniques to evaluate esophageal function
New techniques to evaluate esophageal function
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DOI：
10.1159/000092877
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发表时间：
2006-01-01
影响因子：
2.3
通讯作者：
Blondeau, Kathleen
中科院分区：
文献类型：
--
作者：
Sifrim, Daniel;Blondeau, Kathleen
传统的技术，如视频透视、固定测压和动态24小时ph测定，通常用于临床研究吞咽困难、胸痛和反流相关症状的患者。尽管许多患者可以通过这些技术准确诊断并成功指导他们的治疗，但在许多其他患者中，非阻塞性吞咽困难或胸痛不能归因于清晰的透视或测压异常。此外，24小时动态ph测定通常显示自发性酸反流事件与食管或食管外症状之间的相关性较差，特别是在接受治疗的患者中。非梗阻性吞咽困难可以通过高分辨率测压法来评估，以检测食管痉挛期间食管下括约肌（LES）的节段性蠕动障碍、压力梯度增加或LES轴向运动异常。阻抗评估是一种非放射学的方法，可以评估压力测量异常的功能相关性。对质子泵抑制剂治疗无反应的非心源性胸痛患者可进一步用腔内高频超声检测食管纵肌层的持续收缩。多模态食管刺激的阻抗平面测量有助于评估对机械、热和化学刺激的敏感性。最后，持续出现胃食管反流症状的患者，尽管接受了质子泵抑制剂的充分治疗，但仍可能出现与症状相关的弱酸性反流和/或胆汁反流。现在可以通过ph阻抗或pH-Bilitec监测组合来检测这些类型的回流。这篇综述将描述评估非阻塞性吞咽困难、非心源性胸痛和持续性胃食管反流症状患者的现有新技术。版权所有(c) 2006 S. Karger AG，巴塞尔。
Classical techniques like videofluoroscopy, stationary manometry and ambulatory 24-hour pH-metry are routinely used in the clinic to study patients with dysphagia, chest pain and reflux-related symptoms. Although many patients can be accurately diagnosed and their therapy successfully guided with these techniques, in many other patients, non-obstructive dysphagia or chest pain cannot be attributed to clear fluoroscopic or manometric abnormalities. Furthermore, ambulatory 24-hour pH-metry often shows a poor association between spontaneous acid reflux events and esophageal or extraesophageal symptoms, particularly in patients 'on' treatment. Non-obstructive dysphagia can be assessed with high-resolution manometry to detect segmental disturbances of peristalsis, increase in pressure gradient across the lower esophageal sphincter (LES) or abnormal axial movement of the LES during esophageal spasm. Impedance evaluation of bolus transit is a non-radiological method that can evaluate the functional relevance of manometric abnormalities. Patients with non-cardiac chest pain that do not respond to proton pump inhibitor therapy can be further assessed with intraluminal high-frequency ultrasound to detect sustained esophageal contractions of the longitudinal muscle layer. Impedance planimetry, with multimodal esophageal stimulation, may contribute to evaluate the sensitivity to mechanical, thermal and chemical stimuli. Finally, patients with persistent symptoms of gastroesophageal reflux in spite of adequate treatment with proton pump inhibitors may still have weakly acidic reflux and/or bile reflux associated with their symptoms. These types of refluxates can now be detected with combinations of pH-impedance or pH-Bilitec monitoring. This review will describe the available new techniques to evaluate patients with non-obstructive dysphagia, non-cardiac chest pain and persistent gastroesophageal reflux symptoms. Copyright (c) 2006 S. Karger AG, Basel.