Ineffective esophageal motility in Chicago Classification version 4.0 better predicts abnormal acid exposure
Ineffective esophageal motility in Chicago Classification version 4.0 better predicts abnormal acid exposure
复制标题
DOI：
10.1007/s10388-021-00867-5
复制
发表时间：
2021-08-10
期刊：
影响因子：
2.4
通讯作者：
Xiao, Ying-Lian
中科院分区：
文献类型：
--
作者：
Zhuang, Qian-Jun;Tan, Nian-di;Xiao, Ying-Lian
背景 更新后的芝加哥分类 4.0 版 (CCv4.0) 建立了更严格的标准来诊断无效食管动力 (IEM)。本研究旨在探讨 CCv4.0 中 IEM 在胃食管反流病 (GERD) 背景下的临床意义。方法对2017年至2019年在我中心完成食管功能检查的以胃灼热和/或反流为主要症状的疑似GERD患者进行回顾性研究。根据芝加哥分类3.0版（CCv3.0）将患者进一步分为“CCv3.0 IEM”和运动正常组，根据CCv4.0分为“CCv4.0 IEM”和运动正常组。比较不同组间的临床特征、高分辨率测压、食管反流监测和质子泵抑制剂（PPI）疗效。进行多变量分析以确定与反流负担和症状结果相关的食管运动参数。结果 172 名受试者中，93 名患者被确定为 CCv3.0 IEM，69 名患者被确定为 CCv4.0 IEM。与相应诊断标准中的正常运动相比，任一版本的 IEM 都伴有酸负荷升高和食管清除受损，而 CCv4.0 中唯一存在 IEM 可以预测酸暴露异常（AET > 6%：OR = 2.66，95% CI [1.27-5.56]，p < 0.01）。 “CCv3.0 IEM”和低 EGJ-CI（EGJ-CI < 39.1 mmHg 中心点 cm）的存在在预测反流负担增加方面没有附加价值。在 IEM 的存在和 EGJ 减弱之间没有发现相互作用。没有一个测压变量能够预测 PPI 反应。结论 与 CCv3.0 相比，CCv4.0 中严格的 IEM 标准可以更好地预测异常酸暴露。
Background The updated Chicago Classification version 4.0 (CCv4.0) establishes a more stringent criteria to diagnose ineffective esophageal motility (IEM). This study aims to investigate the clinical significance of IEM in CCv4.0 in the context of gastroesophageal reflux disease (GERD). Methods A retrospective study was conducted among suspected GERD patients who had heartburn and/or regurgitation as their chief complaints and completed esophageal function tests in our center from 2017 to 2019. Patients were further grouped as "CCv3.0 IEM" and normal motility according to Chicago Classification version 3.0 (CCv3.0), and as "CCv4.0 IEM" and normal motility according to CCv4.0. The clinical characteristics, high-resolution manometry, esophageal reflux monitoring, and proton pump inhibitor (PPI) efficacy were compared between different groups. Multivariate analyses were performed to identify esophageal motility parameters associated with reflux burden and symptom outcome. Results Of 172 subjects included, 93 patients were identified as CCv3.0 IEM, 69 as CCv4.0 IEM. IEM in either version was concomitant with elevated acid burden and impaired esophageal clearance as compared to normal motility in corresponding diagnostic criteria, while the only presence of IEM in CCv4.0 was predictive to abnormal acid exposure (AET > 6%: OR = 2.66, 95% CI [1.27-5.56], p < 0.01). The presence of "CCv3.0 IEM" and low EGJ-CI (EGJ-CI < 39.1 mmHg center dot cm) had no added value in predicting increased reflux burden. No interaction effect was found between the presence of IEM and a weakened EGJ. None of the manometric variables was capable of predicting PPI response. Conclusions Stringent criteria of IEM in CCv4.0 can better predict abnormal acid exposure as compared to CCv3.0.