慢性咳嗽和反流患者的食管上括约肌和食管运动性：采用高分辨率测压术进行评价
2012/07/06
摘要
慢性咳嗽的病理生理学及其与食管运动功能障碍和食管咽反流的关系尚不清楚。本试验采用高分辨率测压术（HRM）对慢性咳嗽患者的食管、咽运动性进行详细评价，这些患者有或无阳性反流-咳嗽症状相关概率（SAP）。对66名因慢性咳嗽而就诊的连续患者进行回顾性评价。34名（52%）患者符合入选标准（平均年龄55岁[19～77]，62%为女性）。在咽10口水后进行HRM（ManoScan 360, Given/Sierra Scientific Instruments, Mountain View, CA），随后进行24 h非卧床pH值检测。这些患者中，21名（62%）患者反流-咳嗽SAP阴性（A组），13名（38%）患者存在阳性SAP（B组）。来自23名健康对照个体作为C组。详细分析显示存在明显异质性。小部分患者出现上食道括约肌（UES）功能异常（n=9）或食道运动功能障碍（n=1）。基础状态下，总UES压相似，但A组和B组的平均UES残余压高于对照组（-0.2和-0.8 mmHg vs. -5.4 mmHg; P < 0.018 和P<0.005)。原发性蠕动收缩比率，B组低于A组和C组（56% vs. 79% 和87%; P=0.03和P<0.002）。此外，B组食管下括约肌的食团内压高于C组（15.5 vs. 8.9; P=0.024）。HRM显示慢性咳嗽患者存在UES变化和食道运动功能障碍，这与食团排空受损有关。这些变化在反流-咳嗽症状相关性阳性的B组患者中更为明显。
（陈欣 审校)
Dis Esophagus. 2012 May 16. doi: 10.1111/j.1442-2050.2012.01354.x. [Epub ahead of print]
Upper esophageal sphincter and esophageal motility in patients with chronic cough and reflux: assessment by high-resolution manometry.
Vardar R, Sweis R, Anggiansah A, Wong T, Fox MR.
Source
Ege University School of Medicine, Division of Gastroenterology, Izmir, Turkey Oesophageal Laboratory, St Thomas’ Hospital, London NIHR Biomedical Research Unit and Nottingham Digestive Diseases Centre, Nottingham University Hospitals, QMC Campus, UK.
Abstract
The pathophysiology of chronic cough and its association with dsymotility and laryngopharyngeal reflux remains unclear. This study applied high-resolution manometry (HRM) to obtain a detailed evaluation of pharyngeal and esophageal motility in chronic cough patients with and without a positive reflux-cough symptom association probability (SAP). Retrospective analysis of 66 consecutive patients referred for investigation of chronic cough was performed. Thirty-four (52%) were eligible for inclusion (age 55 [19-77], 62% female). HRM (ManoScan 360, Given/Sierra Scientific Instruments, Mountain View, CA) with 10 water swallows was performed followed by a 24-hour ambulatory pH monitoring. Of this group, 21 (62%) patients had negative reflux-cough SAP (group A) and 13 (38%) had positive SAP (group B). Results from 23 healthy controls were available for comparison (group C). Detailed analysis revealed considerable heterogeneity. A small number of patients had pathological upper esophageal sphincter (UES) function (n = 9) or esophageal dysmotility (n = 1). The overall baseline UES pressure was similar, but average UES residual pressure was higher in groups A and B than in control group C (-0.2 and -0.8 mmHg vs. -5.4 mmHg; P < 0.018 and P < 0.005). The percentage of primary peristaltic contractions was lower in group B than in groups A and C (56% vs. 79% and 87%; P = 0.03 and P < 0.002). Additionally, intrabolus pressure at the lower esophageal sphincter was higher in group B than in group C (15.5 vs. 8.9; P = 0.024). HRM revealed changes to UES and esophageal motility in patients with chronic cough that are associated with impaired bolus clearance. These changes were most marked in group B patients with a positive reflux-cough symptom association.
Dis Esophagus. 2012 May 16. doi: 10.1111/j.1442-2050.2012.01354.x. [Epub ahead of print]
慢性咳嗽的病理生理学及其与食管运动功能障碍和食管咽反流的关系尚不清楚。本试验采用高分辨率测压术（HRM）对慢性咳嗽患者的食管、咽运动性进行详细评价，这些患者有或无阳性反流-咳嗽症状相关概率（SAP）。对66名因慢性咳嗽而就诊的连续患者进行回顾性评价。34名（52%）患者符合入选标准（平均年龄55岁[19～77]，62%为女性）。在咽10口水后进行HRM（ManoScan 360, Given/Sierra Scientific Instruments, Mountain View, CA），随后进行24 h非卧床pH值检测。这些患者中，21名（62%）患者反流-咳嗽SAP阴性（A组），13名（38%）患者存在阳性SAP（B组）。来自23名健康对照个体作为C组。详细分析显示存在明显异质性。小部分患者出现上食道括约肌（UES）功能异常（n=9）或食道运动功能障碍（n=1）。基础状态下，总UES压相似，但A组和B组的平均UES残余压高于对照组（-0.2和-0.8 mmHg vs. -5.4 mmHg; P < 0.018 和P<0.005)。原发性蠕动收缩比率，B组低于A组和C组（56% vs. 79% 和87%; P=0.03和P<0.002）。此外，B组食管下括约肌的食团内压高于C组（15.5 vs. 8.9; P=0.024）。HRM显示慢性咳嗽患者存在UES变化和食道运动功能障碍，这与食团排空受损有关。这些变化在反流-咳嗽症状相关性阳性的B组患者中更为明显。
（陈欣 审校)
Dis Esophagus. 2012 May 16. doi: 10.1111/j.1442-2050.2012.01354.x. [Epub ahead of print]
Upper esophageal sphincter and esophageal motility in patients with chronic cough and reflux: assessment by high-resolution manometry.
Vardar R, Sweis R, Anggiansah A, Wong T, Fox MR.
Source
Ege University School of Medicine, Division of Gastroenterology, Izmir, Turkey Oesophageal Laboratory, St Thomas’ Hospital, London NIHR Biomedical Research Unit and Nottingham Digestive Diseases Centre, Nottingham University Hospitals, QMC Campus, UK.
Abstract
The pathophysiology of chronic cough and its association with dsymotility and laryngopharyngeal reflux remains unclear. This study applied high-resolution manometry (HRM) to obtain a detailed evaluation of pharyngeal and esophageal motility in chronic cough patients with and without a positive reflux-cough symptom association probability (SAP). Retrospective analysis of 66 consecutive patients referred for investigation of chronic cough was performed. Thirty-four (52%) were eligible for inclusion (age 55 [19-77], 62% female). HRM (ManoScan 360, Given/Sierra Scientific Instruments, Mountain View, CA) with 10 water swallows was performed followed by a 24-hour ambulatory pH monitoring. Of this group, 21 (62%) patients had negative reflux-cough SAP (group A) and 13 (38%) had positive SAP (group B). Results from 23 healthy controls were available for comparison (group C). Detailed analysis revealed considerable heterogeneity. A small number of patients had pathological upper esophageal sphincter (UES) function (n = 9) or esophageal dysmotility (n = 1). The overall baseline UES pressure was similar, but average UES residual pressure was higher in groups A and B than in control group C (-0.2 and -0.8 mmHg vs. -5.4 mmHg; P < 0.018 and P < 0.005). The percentage of primary peristaltic contractions was lower in group B than in groups A and C (56% vs. 79% and 87%; P = 0.03 and P < 0.002). Additionally, intrabolus pressure at the lower esophageal sphincter was higher in group B than in group C (15.5 vs. 8.9; P = 0.024). HRM revealed changes to UES and esophageal motility in patients with chronic cough that are associated with impaired bolus clearance. These changes were most marked in group B patients with a positive reflux-cough symptom association.
Dis Esophagus. 2012 May 16. doi: 10.1111/j.1442-2050.2012.01354.x. [Epub ahead of print]
上一篇：
血管紧张素转换酶（ACE）基因插入/缺失多态性和ACE抑制剂相关咳嗽：荟萃分析
下一篇：
百日咳患者的对症治疗
