High-resolution impedance manometry findings in patients with nutcracker esophagus

作者：Hoshino Masato; Sundaram Abhishek; Juhasz Arpad; Yano Fumiaki; Tsuboi Kazuto; Lee Tommy H; Mittal Sumeet K^*

来源：Journal of Gastroenterology and Hepatology, 2012, 27(3): 592-597.

DOI：10.1111/j.1440-1746.2011.06911.x

• esophageal motility disorder
• high-resolution manometry
• nutcracker esophagus

Background and Aim: The objective of this study was to evaluate the association between high-resolution manometry (HRM) and impedance findings and symptoms in patients with nutcracker esophagus (NE). %26lt;br%26gt;Methods: After institutional review board approval retrospective review of a prospectively maintained database identified patients who were diagnosed with NE as per the Chicago classification (distal contractile integral [DCI] %26gt; 5000 mmHg-s-cm) at Creighton University between October 2008 and October 2010. Patients with achalasia or a history of previous foregut surgery were excluded. NE patients were sub-divided into: (i) Segmental (mean distal esophageal amplitude [DEA] at 3 and 8 cm above lower esophageal sphincter [LES] %26lt; 180 mmHg) (ii) Diffuse (mean DEA at 3 and 8 cm above LES %26gt; 180 mmHg) and (iii) Spastic (DCI %26gt; 8000 mmHg-s-cm). %26lt;br%26gt;Results: Forty-one patients (segmental: 13, diffuse: 4, spastic: 24) satisfied study criteria. Patients with segmental NE would have been missed by conventional manometry criteria as their DEA %26lt; 180 mmHg. A higher percentage of patients with spastic NE (63%) had chest pain when compared to patients with segmental NE (23%) and diffuse NE (25%). There was a significant positive correlation between chest pain severity score and DCI while there was no significant correlation between dysphagia severity and DCI. %26lt;br%26gt;Conclusions: In patients diagnosed with NE using the Chicago classification presence and intensity of chest pain increases with increasing DCI. The present criteria (%26gt; 5000 mmHgs-cm) seems to be too sensitive and has poor symptom correlation. Adjusting the criteria to 8000 mmHg-s-cm is more relevant clinically.

• 出版日期2012-3