High-resolution manometry of the EGJ: An analysis of crural diaphragm function in GERD
High-resolution manometry of the EGJ: An analysis of crural diaphragm function in GERD
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DOI：
10.1111/j.1572-0241.2007.01138.x
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发表时间：
2007-05-01
影响因子：
9.8
通讯作者：
Kahrilas, Peter J.
中科院分区：
文献类型：
--
作者：
Pandolfino, John E.;Kim, Hyon;Kahrilas, Peter J.
目的：高分辨率测压（HRM）提供了食管胃交界处（EGJ）高压区的空间增强动态表示，从而可以将脚膈（CD）收缩与呼气下食管括约肌（LES）压力隔离开来。本研究比较了有和无胃食管反流病（GERD）受试者的CD功能。方法：共有75名无症状对照者和156名GERD患者（EGD或pH监测阳性）接受HRM。在五个呼吸周期内分析EGJ轴向压力曲线，以量化CD相对于LES的位置和收缩活力。检查EGJ HRM属性与GERD状态之间的相关性。结果：与对照组或EGD-/pH-患者相比，GERD患者的CD-LES分离显著更大。与对照组（16.9 +/- 1 mmHg）或EGD-/pH-患者（16.7 +/- 0.2 mmHg）相比，GERD患者EGJ压力的吸气增加（EGD-/pH+，11.5 +/-1.9 mmHg; EGD+，10.0 +/- 1.2 mmHg）也明显较少。使用逻辑回归模型，同时检查呼气LES压力，LES-CD分离，吸气EGJ增强，同时控制年龄和BMI，只有吸气增强与GERD有显着的独立关联。结论：EGJ形态的HRM表征与GERD的客观证明相关。虽然LES压力和LES-CD分离均与GERD相关，但在logistic回归分析中，GERD作为分类结局的最强相关性和唯一独立预测因素是CD功能受损，如EGJ压力吸气增强减少所示。
AIM: High-resolution manometry (HRM) provides a spatially enhanced, dynamic representation of the esophagogastric junction (EGJ) high-pressure zone making it possible to isolate the crural diaphragm (CD) contraction from expiratory lower esophageal sphincter (LES) pressure. This study compared CD function of subjects with and without gastroesophageal reflux disease (GERD). METHODS: A total of 75 asymptomatic controls and 156 GERD patients (EGD or pH monitoring positive) underwent HRM. The EGJ axial pressure profile was analyzed over five respiratory cycles to quantify the position and contractile vigor of the CD relative to the LES. Correlations between EGJ HRM attributes and GERD status were examined. RESULTS: GERD patients had significantly greater CD-LES separation compared with either controls or EGD-/pH- patients. GERD patients also had significantly less inspiratory augmentation of EGJ pressure (EGD-/pH+, 11.5 +/- 1.9 mmHg; EGD+, 10.0 +/- 1.2 mmHg) compared with controls (16.9 +/- 1 mmHg) or EGD-/pH- patients (16.7 +/- 0.2 mmHg). Using a logistic regression model that simultaneously examined expiratory LES pressure, LES-CD separation, and inspiratory EGJ augmentation while controlling for age and BMI, only inspiratory augmentation had a significant independent association with GERD. CONCLUSIONS: HRM characterization of EGJ morphology correlates with the objective demonstration of GERD. Although both LES pressure and LES-CD separation are associated with GERD, the strongest association and the only independent predictor of GERD as a categorical outcome in a logistic regression analysis was impaired CD function as indicated by reduced inspiratory augmentation of EGJ pressure.