Impaired deglutitive EGJ relaxation in clinical esophageal manometry: a quantitative analysis of 400 patients and 75 controls
Impaired deglutitive EGJ relaxation in clinical esophageal manometry: a quantitative analysis of 400 patients and 75 controls
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DOI：
10.1152/ajpgi.00252.2007
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发表时间：
2007-10-01
影响因子：
4.5
通讯作者：
Kahrilas, Peter J.
中科院分区：
文献类型：
--
作者：
Ghosh, Sudip K.;Pandolfino, John E.;Kahrilas, Peter J.
临床食道测压中吞咽功能受损的EGJ松弛：一项对400名患者和75名对照的定量分析。Am J Physiol胃肠病肝生理学293：G878-G885,2007。2007年8月9日首次出版；doi：10.1152/ajpgi.00252.2007。-评估吞咽的食管胃交界处(EGJ)松弛是临床测压的一个重要焦点。我们的目的是将自动算法分析应用于高分辨率测压(HRM)研究，以确定区分正常和异常吞咽EGJ松弛的最佳方法。所有473名受试者(73名对照)在吞水时使用36通道固态HRM组件进行研究。患者分为：1)失弛缓症，2)胃底折叠术后，3)无失弛缓症，吞咽功能正常，或4)功能性梗阻(保留蠕动但EGJ松弛不全)。自动化计算机程序通过使用逐渐复杂的分析程序来补偿食道缩短、脚横隔膜收缩和导管移动，评估了EGJ松弛的充分性，所有这些都是潜在的混杂因素。评估EGJ松弛的单传感器方法对检测贲门失弛缓症的灵敏度仅为52%。在所测试的自动人力资源管理分析范例中，以15毫米汞柱为界值的4-S积分松弛压力在检测幽门失弛缓症方面表现最佳，敏感度和特异度分别为98%和96%。我们还确定了一个由26名功能性EGJ梗阻患者组成的异质性组，这些梗阻归因于不同的贲门失弛缓症和其他不同的病理。尽管进一步的临床经验将最终作出判断，但我们期望，将本文所述的严格方法学应用于人力资源管理研究的分析，将提高对临床测压的解释的一致性，并证明对指导临床管理是有用的。
Impaired deglutitive EGJ relaxation in clinical esophageal manometry: a quantitative analysis of 400 patients and 75 controls. Am J Physiol Gastrointest Liver Physiol 293: G878-G885, 2007. First published August 9, 2007; doi:10.1152/ajpgi.00252.2007. - Assessing deglutitive esophagogastric junction ( EGJ) relaxation is an essential focus of clinical manometry. Our aim was to apply automated algorithmic analyses to high-resolution manometry ( HRM) studies to ascertain the optimal method for discriminating normal from abnormal deglutitive EGJ relaxation. All 473 subjects ( 73 controls) were studied with a 36-channel solid-state HRM assembly during water swallows. Patients were classified as: 1) achalasia, 2) postfundoplication, 3) nonachalasia with normal deglutitive EGJ relaxation, or 4) functional obstruction ( preserved peristalsis with incomplete EGJ relaxation). Automated computer programs assessed the adequacy of EGJ relaxation by using progressively complex analysis routines to compensate for esophageal shortening, crural diaphragm contraction, and catheter movement, all potential confounders. The single-sensor method of assessing EGJ relaxation had a sensitivity of only 52% for detecting achalasia. Of the automated HRM analysis paradigms tested, the 4-s integrated relaxation pressure using a cutoff of 15 mmHg performed optimally with 98% sensitivity and 96% specificity in the detection of achalasia. We also identified a heterogeneous group of 26 patients with functional EGJ obstruction attributed to variant achalasia and other diverse pathology. Although further clinical experience will ultimately judge, it is our expectation that applying rigorous methodology such as described herein to the analysis of HRM studies will improve the consistency in the interpretation of clinical manometry and prove useful in guiding clinical management.