The Usefulness of Multiple Rapid Swallows and Semi-solid Swallows for Evaluation of Esophageal Motor Function in Endoscopy-negative Patients with Esophagopharyngeal Symptoms

Alternative Title
Yoo Hyun Jeong
Author(s)
정유현
Alternative Author(s)
Yoo Hyun Jeong
Advisor
이광재
Department
일반대학원 의학과
Publisher
The Graduate School, Ajou University
Publication Year
2020-08
Language
eng
Keyword
Esophageal motility disorderEsophageal symptomHigh resolution manometryMultiple rapid swallowsSemi-solid swallows
Abstract
배경 : 식도 운동 기능의 평가는 통상적으로 single water swallows 방식을 이용하는 고해상도 식도 내압 검사를 기초로 한다. 본 연구는 Multiple rapid swallows 와 Semi-solid swallows를 이용한 방식이, 식도 인두 증상을 호소하나 위장관 내시경상 특이 소견이 없는 환자의 식도 운동 장애에 대해 진단적 효용성을 높일 수 있는지를 평가하고자 함에 그 목표가 있다. 방법: 식도 인두 증상을 호소하나 위장관 내시경상 특이 소견이 없어 water perfused system 의 고해상도 식도 내압 검사를 진행하게 된 환자들을 대상으로 본 연구가 진행되었다. 연구1 은 5ml 의 물을 10회 삼킨 후(single water swallows) MRS를 진행하여 그 결과를 비교하였고, 연구 2 는 single water swallows와 5ml의 pain yoghurt를 10회 삼킨 후 그 결과를 비교하였다. Hypocontractile motility disorders는 mild IEM, servere IEM, absent contractility로 세분화하였다. 연구결과: 연구 1과 2는 각각 240명 (53.30 ± 15.52 세, 여자: 50 %)과 150명 (52.24±15.74 세, 여자: 50.6%)을 대상으로 하였다. 이상 MRS 반응은 mild IEM 환자의 72.7%, severe IEM 환자의 83.8 %, absent contractility 환자의 100%, EGJ outflow obstruction 환자의 73.1%, hypercontractility 환자의 87.5%, DES 환자의 50.0 %, achalasia 환자의 75%에서 나타났다. viscous Yoghurt swallows를 이용하는 고해상도 식도 내압 검사에서는, single water swallows에서 normal HRM 환자의 17.9%, mild IEM 환자의 66.7%, severe IEM 환자의 21.9%, absent contractality 환자의 50%, EGJ outflow obstruction 환자의 15%, DES 환자의 50%, achalasia 환자의 50%에서 진단에 변화가 있었다. 결론: MRS와 Semi-solid swallows의 방식을 이용한 식도 내압 검사는 식도 운동 장애에 대한 진단률을 높일 수 있고, 식도 인두 증상을 호소하나 위장관 내시경상 특이 소견이 없는 환자들에 있어 식도 운동 기능에 관한 임상적으로 적절한 정보를 제공할 수 있을 것으로 기대된다.
Alternative Abstract
Background: The evaluation of esophageal motor function is generally based on high resolution manometry (HRM) with single water swallows. We aimed to evaluate whether multiple rapid swallows (MRS) and semi-solid swallows can increase diagnostic yield for esophageal motility disorders in endoscopy-negative patients with esophagopharyngeal symptoms. Methods: Consecutive endoscopy-negative patients with esophageal or pharyngeal symptoms who underwent HRM using a water perfused system were enrolled in the study. The patients were asked to perform 10 swallows of 5 mL water, followed by MRS (Study 1), and 10 swallows of 5 mL water, followed by 10 swallows of 5 mL semi-solid yoghurt (Study 2). Hypocontractile motility disorders were classified into mild ineffective esophageal motility (IEM), severe IEM (>70% ineffective sequences), and absent contractility. Results: Study 1 and 2 were conducted in 240 patients (53.3±15.5 years, 50% female) and 154 patients (52.2±15.7 years, 50.6% female), respectively. Abnormal MRS responses were observed in 45.6% of patients with normal HRM diagnosis, 72.7% of patients with mild IEM, 83.8% of patients with severe IEM, 100% of patients with absent contractility, 73.1% of patients with esophagogastric junction (EGJ) outflow obstruction, and 87.5% of patients with hypercontractile esophagus, 50% of patients with diffuse esophageal spasm (DES), and 75% of patients with achalasia. In HRM using viscous yoghurt swallows, HRM diagnosis was changed in 17.9 % of patients with normal HRM diagnosis, 66.7% of patients with mild IEM, 21.9% of patients with severe IEM, 50% of patients with absent contractility, 15% of patients with EGJ outflow obstruction, 50% of patients with DES, and 50% of patients with achalasia. Conclusions: MRS and semi-solid yoghurt swallows can increase the diagnostic yield for esophageal motility disorders, and provide clinically relevant information for esophageal motor function in patients with esophageal or pharyngeal symptoms who don’t have no remarkable findings on EGD.
URI
https://dspace.ajou.ac.kr/handle/2018.oak/19836
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Graduate School of Ajou University > Department of Medicine > 3. Theses(Master)
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