Motility Patterns Following Esophageal Pharmacologic Provocation With Amyl Nitrite or Cholecystokinin During High-Resolution Manometry Distinguish Idiopathic vs Opioid-Induced Type 3 Achalasia
Motility Patterns Following Esophageal Pharmacologic Provocation With Amyl Nitrite or Cholecystokinin During High-Resolution Manometry Distinguish Idiopathic vs Opioid-Induced Type 3 Achalasia
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DOI：
10.1016/j.cgh.2019.08.014
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发表时间：
2020-04-01
影响因子：
12.6
通讯作者：
Massey, Benson T.
中科院分区：
文献类型：
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作者：
Babaei, Arash;Shad, Sadaf;Massey, Benson T.
背景和目的：在一些患者中，3 型贲门失弛缓症 (A3) 运动模式可能是长期使用大剂量阿片类药物的结果。尚未发现运动方面的发现可以区分阿片类药物诱导的 A3 (OA3) 和特发性 A3 (IA3)。我们研究了是否可以根据对亚硝酸戊酯、胆囊收缩素或阿托品的食管运动反应的差异来区分 OA3 和 IA3。 方法：我们对 2007 年至 2017 年在三级转诊中心进行食管高分辨率测压期间接受药物激发的患者进行了回顾性研究。我们确定了 26 名 IA3 患者（9 名女性；平均年龄，68 +/- 13 岁）和 24 名 OA3 患者（15 名女性；平均年龄，59 +/- 10 岁）。我们比较了 OA3 与 IA3 患者在吞咽期间和服用亚硝酸戊酯、胆囊收缩素或阿托品后的压力地形图指标。 结果：亚硝酸戊酯在两组患者中引起相似的松弛反应，但在亚硝酸戊酯恢复期间下食管括约肌的回弹收缩，以及缩胆囊素反应第一阶段期间的反常食管收缩均显着减弱OA3 患者。 OA3 患者的胆囊收缩素反应第二阶段在存在时为 100% 松弛，而 IA3 患者的第二阶段胆囊收缩素反应只有 26%。胆碱能受体阻断对下食管括约肌张力或食管体收缩力的抑制作用在各组之间没有显着差异。 结论：近一半患有 A3 型运动障碍的患者是长期、每日使用阿片类药物的患者，其测压模式与 IA3 型患者无法区分。 OA3 患者与 IA3 患者对亚硝酸戊酯和缩胆囊素的反应不同。这些发现可用于识别因使用阿片类药物而导致运动障碍的患者。
BACKGROUND & AIMS: In some patients, the type 3 achalasia (A3) motor pattern may be an effect of chronic use of high-dose opioids. No motor findings have been identified to differentiate opioid-induced A3 (OA3) from idiopathic A3 (IA3). We investigated whether OA3 could be distinguished from IA3 on the basis of differences in esophageal motor responses to amyl nitrite, cholecystokinin, or atropine.METHODS: We performed a retrospective study of patients who received pharmacologic provocation during esophageal high-resolution manometry from 2007 through 2017 at a tertiary referral center. We identified 26 patients with IA3 (9 women; mean age, 68 +/- 13 years) and 24 patients with OA3 (15 women; mean age, 59 +/- 10 years). We compared pressure topography metrics during deglutition and after administration of amyl nitrite, cholecystokinin, or atropine between patients with OA3 vs IA3.RESULTS: Amyl nitrite induced a similar relaxation response in both groups, but the rebound contraction of the lower esophageal sphincter during amyl nitrite recovery, and the paradoxical esophageal contraction during the first phase of cholecystokinin response, were both significantly attenuated in patients with OA3. The second phase of cholecystokinin response in patients with OA3 was 100% relaxation, when present, in contrast to only 26% of patients with IA3. There was no significant difference between groups in inhibition of lower esophageal sphincter tone or esophageal body contractility by cholinergic receptor blockade.CONCLUSIONS: Nearly half of patients with an A3 pattern of dysmotility are chronic, daily users of opioids with manometry patterns indistinguishable from those of patients with IA3. Patients with OA3 differ from patients with IA3 in responses to amyl nitrite and cholecystokinin. These findings might be used to identify patients with dysmotility resulting from opioid use.