Esophageal motility disorders: current concepts of pathogenesis and treatment.
Esophageal motility disorders: current concepts of pathogenesis and treatment.
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食管动力障碍：发病机制和治疗的当前概念。
DOI：
10.1155/2000/389709
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发表时间：
2000
期刊：
影响因子：
--
通讯作者：
Kahrilas,PJ
中科院分区：
文献类型：
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作者：
Kahrilas,PJ
目前的概念食管动力障碍进行了总结。主要数据来源通过MEDLINE或交叉引用查找。没有试图全面或包容的文献，因为只有不到10%的引文被讨论。相反，重点放在诊断，治疗和实践模式的新发展上。强调对照治疗试验和病理生理学观察。贲门失弛缓症是一种罕见的下括约肌松弛失败的疾病。弥漫性食管痉挛（DES）是一种同样罕见的疾病，定义为非传播性食管收缩。非特异性运动障碍，包括胡桃夹食管和高血压下食管括约肌，只能通过测压来确定，并且是十倍的流行。神经肌肉病理学仅在失弛缓症（肌间神经丛神经元破坏）中明显。药物治疗对贲门失弛缓症的疗效有限;对DES的疗效更有限;对非特异性运动障碍无疗效。对非特异性疾病更有效的治疗是针对相关的反流疾病或精神疾病。气囊扩张术对72%的贲门失弛缓症是有效的治疗方法，但经常需要重复扩张，并伴有3%的穿孔率。手术肌切开术在88%的失弛缓症患者中是有效的;开胸手术的发病率一直是主要的限制因素，但腹腔镜手术的发病率已大幅降低。总之，尽管已经表明食管动力障碍是不同的临床实体，但文献的批判性综述仅在贲门失弛缓症的情况下支持这一点，贲门失弛缓症是一种明确定义的病理生理学、功能障碍和治疗方法的疾病。DES和非特异性食管动力障碍的这种清晰度逐渐降低。
Current concepts of esophageal motility disorders are summarized. Primary data sources were located via MEDLINE or cross‐citation. No attempt was made to be comprehensive or inclusive of the literature because fewer than 10% of citations are discussed. Instead, emphasis was placed on new developments in diagnosis, therapeutics, and practice patterns. Controlled therapeutic trials and pathophysiological observations are emphasized. Achalasia is a rare disease of failed lower sphincter relaxation and aperistalsis. Diffuse esophageal spasm (DES), an equally rare disease, is defined by non‐propagated esophageal contractions. Nonspecific motility disorders, including nutcracker esophagus and hypertensive lower esophageal sphincter, are identified only by manometry and are ten times as prevalent. Neuromuscular pathology is evident only with achalasia (myenteric plexus neurons destruction). Pharmacological therapies have limited efficacy with achalasia; more limited with DES; and none with the nonspecific motility disorders. More efficacious therapies for the nonspecific disorders are directed at associated reflux disease or psychiatric disorders. Pneumatic dilation is effective therapy for achalasia 72% of instances, but frequently requires repeat dilation and is complicated by a 3% perforation rate. Surgical myotomy is effective in 88% of achalasics; morbidity from thoracotomy has been the major limitation but this has been sharply reduced with a laparoscopic approach. In conclusion, although it has been suggested that esophageal motility disorders are distinct clinical entities, critical review of the literature supports this only in the case of achalasia, a disease of well defined pathophysiology, functional disturbance, and therapies. This clarity diminishes progressively for DES and non‐specific esophageal motility disorders.