Quantifying esophagogastric junction contractility with a novel HRM topographic metric, the EGJ-Contractile Integral: normative values and preliminary evaluation in PPI non-responders.
Quantifying esophagogastric junction contractility with a novel HRM topographic metric, the EGJ-Contractile Integral: normative values and preliminary evaluation in PPI non-responders.
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DOI：
10.1111/nmo.12267
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发表时间：
2014-03
影响因子：
3.5
通讯作者：
Pandolfino JE
中科院分区：
文献类型：
--
作者：
Nicodème F;Pipa-Muniz M;Khanna K;Kahrilas PJ;Pandolfino JE
尽管其明显的病理生理相关性，食管胃交界处（EGJ）收缩性的措施的临床效用是未经证实的。高分辨率测压（HRM）可以改善这一点，其固有的能力，整合收缩的幅度随着时间和长度的EGJ。本研究旨在开发一种新型HRM指标，总结EGJ收缩性，并测试其区分质子泵抑制剂无反应者（PPI-NR）亚组的能力。对75名正常人和88名PPI-NR进行了研究。所有患者均接受了HRM。PPI-NR在PPI治疗时进行pH阻抗监测，根据酸暴露、反流事件数量和反流-症状相关性进行评分，并按符合所有标准、部分标准或无异常标准分组。对照HRM研究用于建立候选EGJ收缩性指标的正常值，然后比较其区分PPI-NR亚组的能力。EGJ收缩积分（EGJ-CI）是一种对三个呼吸周期的EGJ收缩力进行积分的指标，可最好地区分所有标准PPI-NR亚组与对照组和其他PPI-NR亚组。该测量的正常值（中位数，[IQR]）为39 mmHg-cm [25-55 mmHg-cm]。EGJ-CI与先前提出的指标（下食管括约肌压力积分）之间的相关性较弱，该指标使用固定的10 s时间范围和大气压，而不是胃压参考。在测试的HRM指标中，EGJ-CI在区分符合pH阻抗测试异常所有标准的PPI-NR方面最好。未来的前瞻性研究需要探索其在管理更广泛的GERD患者群体中的效用。
Despite its obvious pathophysiological relevance, the clinical utility of measures of esophagogastric junction (EGJ) contractility is unsubstantiated. High-resolution manometry (HRM) may improve upon this with its inherent ability to integrate the magnitude of contractility over time and length of the EGJ. This study aimed to develop a novel HRM metric summarizing EGJ contractility and test its ability distinguish among subgroups of proton pump inhibitor non-responders (PPI-NRs). 75 normal controls and 88 PPI-NRs were studied. All underwent HRM. PPI-NRs underwent pH-impedance monitoring on PPI therapy scored in terms of acid exposure, number of reflux events, and reflux-symptom correlation and grouped as meeting All Criteria, Some Criteria, or No Criteria of abnormality. Control HRM studies were used to establish normal values for candidate EGJ contractility metrics, which were then compared in their ability to differentiate among PPI-NR subgroups. The EGJ contractile integral (EGJ-CI), a metric integrating contractility across the EGJ for three respiratory cycles, best distinguished the All Criteria PPI-NR subgroup from controls and other PPI-NR subgroups. Normal values (median, [IQR]) for this measure were 39 mmHg-cm [25–55 mmHg-cm]. The correlation between the EGJ-CI and a previously proposed metric, the lower esophageal sphincter-pressure integral, that used a fixed 10s time frame and an atmospheric as opposed to gastric pressure reference was weak. Among HRM metrics tested, the EGJ-CI was best in distinguishing PPI-NRs meeting All Criteria of abnormality on pH-impedance testing. Future prospective studies are required to explore its utility in management of broader groups of GERD patients.