Phenotypes and clinical context of hypercontractility in high-resolution esophageal pressure topography (EPT).
Phenotypes and clinical context of hypercontractility in high-resolution esophageal pressure topography (EPT).
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DOI：
10.1038/ajg.2011.313
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发表时间：
2012-01
影响因子：
9.8
通讯作者：
Kahrilas, Peter J.
中科院分区：
文献类型：
--
作者：
Roman, Sabine;Pandolfino, John E.;Chen, Joan;Boris, Lubomyr;Luger, Daniel;Kahrilas, Peter J.
本研究旨在完善高分辨率食道压力地形图(EPT)中食道过度收缩的标准，并研究其发生的临床背景。72名对照受试者被用来定义远端收缩积分(DCI)大于正常人的收缩功能亢进阈值。回顾了2000项连续的EPT研究，以发现超过这一阈值的患者。探讨伴随的EPT和临床变量。在对照组受试者中观察到的最大DCI值为7,732毫米汞-S-厘米；以吞咽DCI>；8,000毫米汞柱-S-厘米为过度收缩阈值。44例患者的最大DCI中位数为11077毫米汞柱-S-厘米，所有患者的收缩传播和远端收缩潜伏期正常，从而排除了贲门失弛缓症和远端食道痉挛。在82%的病例中，收缩亢进与多峰收缩有关，从而导致了杰克哈默食道的名字。吞咽困难是主要症状，尽管部分患者在EGJ流出道梗阻、反流性疾病或明显的原发运动障碍的情况下有收缩功能亢进。我们描述了一种极端的收缩过度表型，其特征是至少出现一次DCI>；8,000毫米汞-S-厘米收缩，这是在对照组受试者中没有遇到的值。这种现象，品牌杰克哈默食道通常伴有吞咽困难，并与其他食道病理(EGJ流出梗阻、反流病)或作为单独的运动障碍而发生。需要进一步的研究来确定这种疾病的病理生理学和治疗方法。
This study aimed to refine the criteria for esophageal hypercontractility in high resolution esophageal pressure topography (EPT) and examine the clinical context in which it occurs. 72 control subjects were used to define the threshold for hypercontractility as a distal contractile integral (DCI) greater than observed in normals. 2,000 consecutive EPT studies were reviewed to find patients exceeding this threshold. Concomitant EPT and clinical variables were explored. The greatest DCI value observed in any swallow among the control subjects was 7,732 mmHg-s-cm; the threshold for hypercontractility was established as a swallow with DCI >8,000 mmHg-s-cm. 44 patients were identified with a median maximal DCI of 11,077 mmHg-s-cm, all with normal contractile propagation and normal distal contractile latency, thereby excluding achalasia and distal esophageal spasm. Hypercontractility was associated with multipeaked contractions in 82% of instances leading to the name Jackhammer Esophagus . Dysphagia was the dominant symptom although subsets of patients had hypercontractility in the context of EGJ outflow obstruction, reflux disease, or as an apparent primary motility disorder. We describe an extreme phenotype of hypercontractility characterized in EPT by the occurrence of at least a single contraction with DCI > 8,000 mmHg-s-cm, a value not encountered in control subjects. This phenomenon, branded Jackhammer Esophagus was usually accompanied by dysphagia and occurred both in association with other esophageal pathology (EGJ outflow obstruction, reflux disease) or as an isolated motility disturbance. Further studies are required to define the pathophysiology and treatment of this disorder.
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DOI：
10.1152/ajpgi.00510.2005
发表时间：
2006-05-01
影响因子：
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DOI：
10.1152/ajpgi.00252.2007
发表时间：
2007-10-01
影响因子：
4.5
作者：
Ghosh, Sudip K.;Pandolfino, John E.;Kahrilas, Peter J.
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