Characterization and follow-up of esophagogastric junction outflow obstruction detected by high resolution manometry
Characterization and follow-up of esophagogastric junction outflow obstruction detected by high resolution manometry
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DOI：
10.1111/nmo.12708
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发表时间：
2016-01-01
影响因子：
3.5
通讯作者：
Chavarria-Herbozo, C.
中科院分区：
文献类型：
--
作者：
Perez-Fernandez, M. -T.;Santander, C.;Chavarria-Herbozo, C.
背景食管胃交界处流出道梗阻（EGJOO）是一种新的诊断实体，由于高分辨率测压（HRM）的使用，其重要性日益增加。关于其发病率、病因、长期演变和最合适的治疗方法知之甚少。我们的目标是提高认识EGJOO优化管理这些patients.MethodsWe进行了一个历史（回顾性和前瞻性）研究诊断EGJOO使用HRM结合多通道腔内阻抗的患者，比较他们的测压和阻抗特性与对照组。症状，梗阻，酸暴露，临床过程（及其相关因素），并对治疗的反应也进行了评价EGJOO group.Key ResultsForty-four受试者（28例患者和16例对照）。食管胃交界处流出道梗阻患者的食管传输不完全率高于对照组。结构性梗阻的患者吞咽困难的发生率高于功能性梗阻的患者，并且具有不同的测压、阻抗和pH测量模式。超过三分之一的EGJOO患者在没有EGJOO治疗的情况下症状自发消退。在多变量分析中，与这种自发性症状缓解相关的变量包括胃食管反流病或上腹痛的典型症状作为主要症状和上食管括约肌的静息或基础压力
BackgroundEsophagogastric junction outflow obstruction (EGJOO) is a newly described diagnostic entity growing in importance due to the use of high resolution manometry (HRM). There is little knowledge regarding its incidence, etiopathogeny, long-term evolution, and most suitable treatment. Our objective was to increase the awareness of EGJOO to optimize the management of these patients.MethodsWe conducted a historical (retrospective and prospective) study of patients diagnosed with EGJOO using HRM combined with multichannel intraluminal impedance, comparing their manometric and impedance characteristics with those of a control group. Symptoms, etiology of obstruction, acid exposure, clinical course (and its associated factors), and response to treatment were also evaluated in the EGJOO group.Key ResultsForty-four subjects were included (28 patients and 16 controls). Esophagogastric junction outflow obstruction patients presented incomplete esophageal transit more frequently than controls. Patients with structural obstruction had dysphagia more frequently than patients with functional obstruction, and different manometric, impedance, and pH-metric patterns. Over one-third of the EGJOO patients presented a spontaneous resolution of symptoms without EGJOO treatment. In the multivariate analysis, the variables associated with this spontaneous symptomatic resolution included typical symptoms of gastro-esophageal reflux disease or epigastralgia as the main symptom and resting or basal pressure of the upper esophageal sphincter