食管测压在不典型贲门失弛缓症诊断中的应用

早期或不典型贲门失弛缓症临床诊断较难,X线钡餐检查敏感性较低.该病可能与食管动力障碍有关,食管测压对其诊断可能有较高的价值.目的:通过分析不典型贲门失弛缓症患者的食管测压参数,探讨其特征性表现,为早期诊断提供依据.方法:对21例不典型贲门失弛缓症、15例典型贲门失弛缓症和10名健康对照者进行食管压力测定.结果:不典型贲门失弛缓症组与典型贲门失弛缓症组的LES静息压类似,但均显著高于健康对照组(P＜0.01).健康对照组、不典型贲门失弛缓症组和典型贲门失弛缓症组的LES残余压呈递增趋势,且两两比较有显著差异(P＜0.01);不典型贲门失弛缓症组仅6例(28.6%)患者LES静息压增加,但有14例(67.7%)LES残余压增加.不典型贲门失弛缓症组50.2%的患者吞咽后LES可完全松弛,松弛率与典型贲门失弛缓症组比较无显著差异,但显著低于健康对照组(P＜0.01).食管体部收缩振幅在三组间无显著差异,多数失弛缓症患者湿咽后表现为无传导性同步收缩,与健康对照组比较有显著差异(P＜0.01).结论:不典型和典型贲门失弛缓症患者的LES静息压和LES松弛率均显著高于健康对照组,但用于诊断贲门失弛缓症敏感性较低.LES残余压对不典型贲门失弛缓症的诊断有较高的敏感性.吞咽后食管体部无传导性同步收缩是所有贲门失弛缓症患者的特征.

Effects of Esophageal Manometry in Diagnosis of Atypical Achalasia

Background: It is difficult to make clinical diagnosis of early or atypical achalasia. The sensitivity of barium meal examination is low, however the esophageal motility disorder may be involved in the pathogensis of the disease, and esophageal manometry has higher diagnostic value in atypical achalasia. Aims: To analyze the esophageal manometric parameters in patients with atypical achalasia, and to provide the evidence for its early diagnosis. Methods: The esophageal manometric parameters of 21 patients with atypical achalasia, 15 typical achalasia and 10 healthy controls were analyzed, respectively. Results: The lower esophageal sphincter (LES) pressure and LES remnant pressure increased progressively in the atypical and typical achalasia groups, which were significantly higher than those in the healthy control group. In all three groups, the LES remnant pressure showed a gradual increasing trend. Only 6 (28.6%) atypical achalasia patients showed higher LES pressure and 14 (67.7%) showed higher LES remnant pressure. LES relaxation rate in atypical achalasia patients was significantly lower than that in the healthy control group (P<0.01), but no significant difference was found between the atypical and typical achalasia groups. As many as 50.2% of atypical achalasia patients could relax completely after swallowing. There were three types of motor patterns concerning contraction amplitude of esophageal body, but no significant difference was found among the three groups. Non-conductional synchronous contractions in the esophageal body were detected in most achalasia patients with significant difference when compared with that of the healthy control group (P<0.01). Conclusions: LES pressure and LES relaxation rate are significantly higher in achalasia patients than those in healthy control group, but the sensitivity for diagnosis of achalasia is relatively low. On the contrary, LES remnant pressure is more sensitive in the diagnosis of atypical achalasia. Non-conductional synchronous contractions in the esophageal body are the manometric characteristics in common in both atypical and typical achalasia groups after swallowing.