Esophagogastric junction contractility for clinical assessment in patients with GERD: a real added value?
Esophagogastric junction contractility for clinical assessment in patients with GERD: a real added value?
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DOI：
10.1111/nmo.12638
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发表时间：
2015-10-01
影响因子：
3.5
通讯作者：
Savarino, E.
中科院分区：
文献类型：
--
作者：
Tolone, S.;De Bortoli, N.;Savarino, E.
背景：食管胃交界处收缩积分（EGJ-CI）通过高分辨率测压（HRM）评估的作用尚不清楚。我们的目的是将EGJ-CI与胃食管反流病（GERD）患者的阻抗-pH结果相关联。方法收集有GERD症状的连续性患者。所有患者均接受了上消化道内镜检查、HRM和阻抗-pH检测。在三个连续的呼吸周期中，使用远端收缩积分工具箱计算EGJ-CI。然后将该值除以这些周期的持续时间。低于13的值被认为是有缺陷的EGJ-CI。我们还评估了EGJ形态、食管酸暴露时间（AET）、反流发作次数（NRE）和症状关联分析（SAA）。如果AET和/或NRE异常和/或SAA阳性，则考虑进行正阻抗-pH监测。关键结果在我们入组的130例患者中，91例有GERD（AET异常和/或NRE升高和/或SAA阳性），39例有功能性烧心（FH）（内镜检查阴性，AET正常，NRE正常，SAA阴性）。与FH患者相比，GERD患者的EGJ-CI中位数较低（11 [3.1-20.7] vs 22 [9.9-41]，p < 0.02）。与EGJ-CI正常的患者相比，EGJ-CI缺陷的患者在内窥镜检查时更常出现阻抗-pH监测阳性或食管粘膜病变（分别为p < 0.05和p < 0.05）。EGJ-CI临界值为5 mmHg cm时，在阻抗-pH下识别GERD的性能最佳（灵敏度89%-特异性63%）。结论（原文如此）推论HRM的EGJ-CI缺陷与阻抗-pH监测的GERD证据明显相关。评价EGJ-CI可能有助于预测阻抗-pH测试异常。
Background The role of esophagogastric junction contractile integral (EGJ-CI) as assessed by high-resolution manometry (HRM) is unclear. We aimed to correlate the EGJ-CI with impedance-pH findings in gastro-esophageal reflux disease (GERD) patients. Methods Consecutive patients with GERD symptoms were enrolled. All patients underwent upper endoscopy, HRM, and impedance-pH testing. The EGJ-CI was calculated using the distal contractile integral tool box during three consecutive respiratory cycles. The value was then divided by the duration of these cycles. A value below 13 was considered as a defective EGJ-CI. We also assessed EGJ morphology, esophageal acid exposure time (AET), number of reflux episodes (NRE), and symptom association analysis (SAA). A positive impedance-pH monitoring was considered in case of abnormal AET and/or NRE and/or positive SAA. Key Results Among 130 patients we enrolled, 91 had GERD (abnormal AET and/or elevated NRE and/or positive SAA) and 39 had functional heartburn (FH) (negative endoscopy, normal AET, normal NRE, and negative SAA). The GERD patients had a lower median value of EGJ-CI (11 [3.1-20.7] vs 22 [9.9-41], p < 0.02) compared to FH patients. Patients with a defective EGJ-CI had, more frequently, a positive impedance-pH monitoring or esophageal mucosal lesions at endoscopy (p < 0.05 and p < 0.05, respectively) than patients with a normal EGJ-CI. An EGJ-CI cut-off value of 5 mmHg cm yielded the optimal performance in identifying GERD at impedance-pH (sensitivity 89%-specificity 63%). Conclusions (sic) Inferences A defective EGJ-CI at HRM is clearly associated with evidence of GERD at impedance-pH monitoring. Evaluating EGJ-CI may be useful to predict an abnormal impedance-pH testing.