无效食管动力临床特征分析

Analysis of clinical characteristics of ineffective esophageal motility

目的分析无效食管动力(IEM)的临床特征。方法选择2021年7月至2022年7月因胃食管反流病(GERD)样症状或吞咽梗阻于四川大学华西医院行高分辨率食管测压及食管24 h pH监测的患者338例。根据IEM发生情况将其分为正常食管动力组(n=264)和IEM组(n=74)。比较两组人口学特征、食管测压数据、酸暴露时间百分比(AET)、临床症状及对质子泵抑制剂治疗的反应情况。结果IEM组男性人数比例大于正常食管动力组,胃食管结合部(EGJ)基础压低于正常食管动力组,差异有统计学意义(P<0.05)。两组年龄、体质量指数、EGJ分型比较差异无统计学意义(P>0.05)。两组反酸/烧心、胸痛、咽喉不适、吞咽梗阻、非特异症状发生情况比较差异无统计学意义(P>0.05)。IEM组总AET>4.0%、立位AET>6.0%及卧位AET>2.0%人数比例均高于正常食管动力组,差异有统计学意义(P<0.05)。两组抑酸治疗有效率差异无统计学意义(52.08%vs 47.37%;χ^(2)=0.341,P=0.559)。多因素logistic回归分析结果显示,IEM和Ⅱ/Ⅲ型EGJ是促进GERD发生的独立危险因素(P<0.05);较高的EGJ基础压力是抑制GERD发生的保护因素(P<0.05)。结论IEM与食管酸暴露增加有关,临床表现不具有特异性,IEM对质子泵抑制剂的疗效无显著影响。

Objective To analyze the clinical characteristics of ineffective esophageal motility(IEM).Methods Three hundred and thirty-eight patients who underwent high-resolution esophageal manometry and 24-hour esophageal pH monitoring in West China Hospital of Sichuan University from July 2021 to July 2022 due to gastroesophageal reflux disease(GERD)-like symptoms or dysphagia were selected.According to the occurrence of IEM,the patients were divided into normal esophageal motility group(n=264)and IEM group(n=74).The demographic characteristics,data of esophageal manometry,percentage of acid exposure time(AET),clinical symptoms and response to proton pump inhibitor therapy were compared between the two groups.Results The proportion of males in the IEM group was significantly higher than that in the normal esophageal motility group,and the mean basal esophagogastric junction(EGJ)pressure in the IEM group was significantly lower than that in the normal esophageal motility group(P<0.05).There were no significant differences in age,body mass index and EGJ type between the two groups(P>0.05).There were no significant differences in the incidence rates of acid reflux/heartburn,chest pain,throat discomfort,dysphagia and non-specific symptoms between the two groups(P>0.05).The proportions of total AET>4.0%,upright AET>6.0%and supine AET>2.0%in the IEM group were significantly higher than those in the normal esophageal motility group(P<0.05).There was no statistically significant difference in the effective rate of acid-suppression therapy between the two groups(52.08%vs 47.37%;χ^(2)=0.341,P=0.559).The results of multivariate logistic regression analysis showed that IEM and EGJ typeⅡ/Ⅲwere independent risk factors for promoting GERD(P<0.05),and higher mean basal EGJ pressure was a protective factor against GERD(P<0.05).Conclusion IEM is associated with increased exposure to esophageal acid,and the clinical manifestations are not specific,and IEM has no significant effect on the efficacy of proton pump inhibitors.