多次快速吞咽在无效食管动力中的诊断价值

Diagnostic Value of Multiple Rapid Swallows in Ineffective Esophageal Motility

背景:无效食管动力(IEM)是一种常见的食管动力障碍,多次快速吞咽(MRS)测试可反映其食管收缩储备功能。目的:分析IEM患者的MRS测试结果,探索MRS在IEM中的诊断价值。方法:连续纳入2018年1月—2020年1月在南京医科大学第一附属医院经食管测压诊断为IEM或正常食管动力(NEM)并加做MRS测试者。采集人口统计学和临床资料以及高分辨率食管测压、MRS测试、24 h食管pH-阻抗监测结果,按不同分组进行分析比较。其中多次MRS的平均远端收缩积分(DCI)与10次湿咽(SS)的平均DCI比值>1表示存在食管储备功能;单次MRS的DCI与10次SS的平均DCI比值>1表示MRS后有改善。结果:(1)IEM组与NEM组比较:两组间食管储备功能无明显差异,但IEM组食管胃连接处收缩积分(EGJ-CI)更低(P<0.05)。(2)IEM组有或无食管储备功能亚组比较:无储备组蠕动波幅更低,蠕动失败个数更多(P均<0.05)。IEM的严重程度(蠕动失败百分比)与食管储备功能呈显著负相关(r=-0.436,P<0.05)。两组间反流症状和反流发生率无明显差异。(3)IEM组3次MRS测试完全、部分、无改善亚组比较:完全改善组下食管括约肌压力(LESP)最高,无改善组最低(P<0.05)。无改善组无效吞咽百分比最高(P<0.05)。结论:MRS是判断IEM患者食管收缩储备功能的重要指标,有或无食管储备功能的IEM患者反流发生率无明显差异。综合3次MRS的改善率评估IEM严重程度更为合理。

Background:Ineffective esophageal motility(IEM)is a common esophageal motility disorder,its contraction reserve can be evaluated by multiple rapid swallows(MRS).Aims:To analyze the results of MRS test in patients with IEM,and further explore the value of MRS in the diagnosis of IEM.Methods:Individuals with IEM or normal esophageal motility(NEM)confirmed by manometry and undergoing MRS test were included consecutively from January 2018 to January 2020 at the First Affiliated Hospital of Nanjing Medical University.The demography,clinical data,and the results of high-resolution esophageal manometry,MRS test and 24 h esophageal pH-impedance monitoring were collected for analyses based on different subtyping.Esophageal contraction reserve was defined as the ratio between the mean distal contractile index(DCI)of 2-3 MRS and the mean DCI of 10 single swallows(SS)>1,while improvement after MRS was defined as the ratio between the DCI of a single MRS and the mean DCI of 10 SS>1.Results:1)There was no difference in contraction reserve between IEM group and NEM group,but the esophagogastric junction contractile integral(EGJ-CI)in IEM group was lower than that in NEM group(P<0.05).2)In IEM patients without contraction reserve,the amplitude of peristalsis was lower,and more failed contraction was observed as compared with those with contraction reserve(all P<0.05).Furthermore,the severity of IEM(percentage of failed contractions)was negatively correlated with the contraction reserve function(r=-0.436,P<0.05).There were no significant differences in the reflux symptoms and the incidence of reflux between the two groups.3)Among complete,partial and non improvement groups(improvement was achieved in 3,1-2 and 0 MRS test),the lower esophageal sphincter pressure(LESP)was the highest in complete improvement group,and being the lowest in non improvement group(P<0.05).The percentage of ineffective swallows was the highest in non improvement group(P<0.05).Conclusions:MRS is an important indicator for evaluation of the contraction reserve in IEM patients.The incidence of reflux is not significantly different in IEM patients with or without contraction reserve function.Improvement rate of three repeated MRS test is reliable for the evaluation of the severity of IEM.