食道过度收缩：临床表现，刺激试验在高分辨率测压中的作用和来自亚洲队列的长期结果

IF 2.9 3区医学 Q1 CLINICAL NEUROLOGY

Neurogastroenterology and Motility Pub Date : 2025-07-23 DOI:10.1111/nmo.70129

Daphne Ang, Seok-Hwee Koo, Wallace Bok-Thoe Hong, Jonathan Zi-Yang Kuang, Andrew Xia-Huang Tan

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A telephone survey was conducted between January and June 2023 using Impaction Dysphagia Questionnaire [IDQ], Eckardt scores, and the Gastro-Esophageal Reflux Disease Questionnaire (GERD-Q) to determine long-term outcomes.Results: Forty-eight patients (29 [60.4%] Female, 63.0 [13.4] years) with HS who presented with dysphagia (60%), reflux (37.5%) and chest pain (29.2%) and 58 controls (28 [48.3%] Female, 49 [13.4] years) with dysphagia (n = 43.1%), reflux (n = 41.4%) and chest pain (15.5%) with normal HRM findings were identified from 454 studies performed. More patients had HS with STM versus SWS (n = 41 [85.4%] vs. n = 7 [14.6%], p < 0.001). Dysphagia was significantly associated with mean DCI (B = 0.000, p = 0.035) and maximal DCI (B = 0.000, p = 0.036) during STM. 43% (n = 3/7) and 22% (n = 9/41) of patients with ≥ 2 HS using SWS and STM respectively were on medical therapy at mean (SD) clinic follow-up of 28.7 (29.2) months. 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引用次数: 0

摘要

背景：食管超收缩性（HE）是罕见的。食管高分辨率测压（HRM）与固体试餐（STM）在芝加哥分类（CCv4.0）中可以提高诊断率，但缺乏结果数据。目的：评价HE的临床特点及远期预后，探讨仅用STM检测心肌超缩的临床意义。方法：2014年6月至2021年12月，在单燕子（SWS）和/或STM的HRM研究中，对所有≥2只高收缩性燕子（HS）（远端收缩积分[DCI] > 8000mmhg .s.cm）患者进行单中心分析。在2023年1月至6月期间，使用嵌塞吞咽困难问卷（IDQ）、Eckardt评分和胃食管反流疾病问卷（GERD-Q）进行电话调查，以确定长期结果。结果：在进行的454项研究中，48例HS患者（29例[60.4%]女性，63.0[13.4]岁）表现为吞咽困难（60%）、反流（37.5%）和胸痛（29.2%），对照组（28例[48.3%]女性，49例[13.4]岁）表现为吞咽困难（n = 43.1%）、反流（n = 41.4%）和胸痛（15.5%），HRM正常。STM合并HS的患者多于SWS （n = 41 [85.4%] vs. n = 7[14.6%]）。结论：STM提高了HS的诊断率，并发现了更多从药物治疗中受益的患者。

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Hypercontractile Esophagus: Clinical Presentation, Role of Provocative Tests in High Resolution Manometry and Long Term Outcome-Results From an Asian Cohort.

Background: Hypercontractile esophagus (HE) is rare. Esophageal high-resolution manometry (HRM) with solid test meal (STM) in Chicago Classification (CCv4.0) may improve diagnostic yield, but outcome data are lacking.

Aim: Evaluate the clinical features and long-term outcome of HE, and determine the clinical significance of hypercontractility detected only using STM.

Methods: Single-center analysis of all patients with ≥ 2 hypercontractile swallows (HS) (distal contractile integral [DCI] > 8000 mmHg.s.cm) on HRM studies with single water swallows (SWS) and/or STM between June 2014 and December 2021. A telephone survey was conducted between January and June 2023 using Impaction Dysphagia Questionnaire [IDQ], Eckardt scores, and the Gastro-Esophageal Reflux Disease Questionnaire (GERD-Q) to determine long-term outcomes.

Results: Forty-eight patients (29 [60.4%] Female, 63.0 [13.4] years) with HS who presented with dysphagia (60%), reflux (37.5%) and chest pain (29.2%) and 58 controls (28 [48.3%] Female, 49 [13.4] years) with dysphagia (n = 43.1%), reflux (n = 41.4%) and chest pain (15.5%) with normal HRM findings were identified from 454 studies performed. More patients had HS with STM versus SWS (n = 41 [85.4%] vs. n = 7 [14.6%], p < 0.001). Dysphagia was significantly associated with mean DCI (B = 0.000, p = 0.035) and maximal DCI (B = 0.000, p = 0.036) during STM. 43% (n = 3/7) and 22% (n = 9/41) of patients with ≥ 2 HS using SWS and STM respectively were on medical therapy at mean (SD) clinic follow-up of 28.7 (29.2) months. At mean (SD) follow-up telephone survey of 61.3 (27.1) months from HRM, symptom scores amongst 36/48 (75%) patients and 58 controls were: IDQ (3.8 [0-4] vs. 1.0 [0-1.3], p = 0.03); Eckardt dysphagia score (0.46 [0.0-1.0] vs. 0.14 [0-0], p = 0.007); GerdQ (6.4 [6.0-6.0] vs. 7.0 [6.0-8.0], pNS) respectively.

Conclusions: STM enhanced diagnostic yield of HS and identified more patients who benefitted from medical therapy.

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来源期刊

Neurogastroenterology and Motility 医学-临床神经学

CiteScore

7.80

自引率

8.60%

发文量

178

审稿时长

3-6 weeks

期刊介绍： Neurogastroenterology & Motility (NMO) is the official Journal of the European Society of Neurogastroenterology & Motility (ESNM) and the American Neurogastroenterology and Motility Society (ANMS). It is edited by James Galligan, Albert Bredenoord, and Stephen Vanner. The editorial and peer review process is independent of the societies affiliated to the journal and publisher: Neither the ANMS, the ESNM or the Publisher have editorial decision-making power. Whenever these are relevant to the content being considered or published, the editors, journal management committee and editorial board declare their interests and affiliations.