Spectrum of esophageal dysmotility in systemic sclerosis on high-resolution esophageal manometry as defined by Chicago classification
Spectrum of esophageal dysmotility in systemic sclerosis on high-resolution esophageal manometry as defined by Chicago classification
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DOI：
10.1093/dote/dox067
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发表时间：
2017-12-01
影响因子：
2.6
通讯作者：
Thota, P. N.
中科院分区：
文献类型：
--
作者：
Aggarwal, N.;Lopez, R.;Thota, P. N.
系统性硬化症的经典测压表现是食管体部闭锁伴食管下括约肌扩张。这些变化有助于这些患者的胃食管反流病。随着高分辨率食管测压的广泛使用，可以看到各种异常。本研究的目的是描述接受高分辨率食管测压的系统性硬化症患者的食管动力障碍，并比较不同程度食管动力障碍患者的人口统计学特征和诊断测试结果。确定了2008年1月至2014年10月期间在我们机构接受高分辨率食管测压的系统性硬化症患者。使用芝加哥分类v3.0标准重新解释高分辨率食管测压研究。我们还审查了患者图表的人口统计学数据、测压适应症、食管胃镜检查结果、pH值研究、药物使用和自身抗体组。该队列包括122例患者，平均年龄为53.3 ± 15.3岁。23例高分辨率食管测压正常，22例食管动力无效，73例无收缩力，II型贲门失弛缓症、食管胃交界处流出道梗阻、食管收缩亢进和远端食管痉挛各1例。与食管动力无效或测压正常的患者相比，缺乏收缩力的患者更年轻，更容易发生糜烂性食管炎、食管裂孔疝和食管狭窄。基于自身抗体或测压适应症的组间无统计学显著差异。在系统性硬化症患者中观察到不同的食管动力异常，在超过四分之三的患者中观察到无效的食管动力或缺乏收缩力。缺乏收缩力的患者更年轻，反流更严重。胃食管反流病相关内镜检查结果的严重程度与高分辨率食管测压的食管动力障碍程度相关。
The classic manometric findings in systemic sclerosis are aperistalsis of the esophageal body with hypotensive lower esophageal sphincter. These changes contribute to gastroesophageal reflux disease in these patients. With widespread use of high-resolution esophageal manometry, diverse abnormalities are seen. The aim of this study is to characterize esophageal dysmotility in patients with systemic sclerosis undergoing high-resolution esophageal manometry and compare demographic features and diagnostic test results among patients with varying degrees of esophageal dysmotility. Patients with systemic sclerosis who underwent high-resolution esophageal manometry between January 2008 and October 2014 at our institution were identified. High-resolution esophageal manometry studies were reinterpreted using the Chicago Classification, v3.0 criteria. We also reviewed the patient charts for demographic data, indications for manometry, esophagogastroduodenoscopy findings, pH studies, medication use, and autoantibody panel. The cohort consisted of 122 patients with a mean age of 53.3 +/- 15.3 years. High-resolution esophageal manometry was normal in 23, showed ineffective esophageal motility in 22, absent contractility in 73, and one case each of type II achalasia, esophagogastric junction outflow obstruction, hypercontractile esophagus, and distal esophageal spasm. Patients with absent contractility were younger and more likely to have erosive esophagitis, hiatal hernia, and esophageal strictures than patients with ineffective esophageal motility or normal manometry. There were no statistically significant differences in the groups based on autoantibodies or indications for manometry. Diverse esophageal motility abnormalities were noted in systemic sclerosis with ineffective esophageal motility or absent contractility observed in over three-fourth of the patients. Patients with absent contractility were younger and had more severe reflux. The severity of gastroesophageal reflux disease related endoscopic findings correlated with the degree of esophageal dysmotility on high-resolution esophageal manometry.