Functional aspects of distal oesophageal spasm: The role of onset velocity and contraction amplitude on bolus transit

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• 作者：Daniel Pohl^a ; ^b ; ^{Daniel.Pohl@usz.ch} ; Jody Ciolino^c ; Jason Roberts^a ; Edoardo Savarino^d ; Janice Freeman^b ; Paul J. Nietert^c ; Radu Tutuian^e ; Donald Castell^b
• 关键词：Bolus transit ; Chest pain ; DES ; Diffuse oesophageal spasm ; Distal oesophageal spasm ; Dysphagia ; GERD ; Impedance manometry ; MII-EM
• 刊名：Digestive and Liver Disease
• 出版年：2012
• 期刊代码：79_15908658
• 类别：med
• 出版时间：July, 2012
• 卷：44
• 期：7
• 页码：569-575
• 文件大小：699 K

摘要

Background

Distal oesophageal spasm is a rare and under-investigated motility abnormality. Recent studies indicate effective bolus transit in varying percentages of distal oesophageal spasm patients.

Aim

Explore functional aspects including contraction onset velocity and contraction amplitude cut-off values for simultaneous contractions to predict complete bolus transit.

Methods

We re-examined data from 107 impedance-manometry recordings with a diagnosis of distal oesophageal spasm. Receiver operating characteristic analysis was conducted, regarding effects of onset velocity on bolus transit taking into account distal oesophageal amplitude and correcting for intra-individual repeated measures.

Results

Mean area under the receiver operating characteristic curve for saline and viscous swallows were 0.84 卤 0.05 and 0.84 卤 0.04, respectively. Velocity criteria of >30 cm/s when distal oesophageal amplitude > 100 mmHg and 8 cm/s when distal oesophageal amplitude < 100 mmHg for saline and 32 cm/s when distal oesophageal amplitude > 100 mmHg and >7 cm/s when distal oesophageal amplitude < 100 mmHg for viscous had a sensitivity of 75%and specificity of 80%to identify complete bolus transit. Using these criteria, final diagnosis changed in 44.9%of patients. Abnormal bolus transit was observed in 50.9%of newly diagnosed distal oesophageal spasm patients versus 7.5%of patients classified as normal. Distal oesophageal spasm patients with distal oesophageal amplitude > 100 mmHg suffered twice as often from chest pain than those with distal oesophageal amplitude < 100 mmHg.

Conclusion

The proposed velocity cut-offs for diagnosing distal oesophageal spasm improve the ability to identify patients with spasm and abnormal bolus transit.