非梗阻性吞咽困难中食管动力障碍的临床谱：一项多中心、多种族研究。
Clinical Spectrum of Esophageal Motility Disorders in Nonobstructive Dysphagia: A Multicenter, Multiethnic Study.
文献信息
| PMID | 42710884 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Jun Xin Lim |
| 作者单位 | Gastroenterology and Hepatology Unit, Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia. |
| 期刊 | Journal of gastroenterology and hepatology |
| SCI 分区 | Q2 |
| IF | 3.8 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
背景与目的： 非梗阻性吞咽困难（NOD）是一种常见的临床情况。亚洲人群中潜在食管动力障碍的谱系仍未完全明确。我们旨在定义NOD的测压谱，识别贲门失弛缓症的预测因素，并评估激发试验的诊断价值。
方法： 这项回顾性多中心研究纳入了2014年至2023年在马来西亚两家三级医院因NOD接受高分辨率测压（HRM）的成人。诊断根据芝加哥分类v3.0进行分类。评估了贲门失弛缓症的临床预测因素。探讨了快速饮水挑战（RDC）整合松弛压力（IRP）在区分贲门失弛缓症与非贲门失弛缓症中的判别性能。
结果： 在230例患者中（平均年龄53.3岁；47.0%为男性），贲门失弛缓症占23.9%，食管胃交界处流出道梗阻（EGJOO）占17.3%，无效食管动力占24.8%。体重减轻（调整OR 2.99，95% CI 1.25-7.15，p=0.014）、无消化不良（调整OR 0.09，95% CI 0.02-0.45，p=0.004）以及存在恶心/呕吐（调整OR 3.35，95% CI 1.34-8.40，p=0.010）独立预测贲门失弛缓症。RDC-IRP在区分贲门失弛缓症与非贲门失弛缓症方面表现出强判别力（AUC 0.894，95% CI 0.794-0.993，p<0.001），最佳阈值约为18 mmHg（敏感性90%，特异性76.9%）。
结论： 在三级医疗环境中，贲门失弛缓症占因NOD接受评估患者的相当大比例。特定的临床特征可能有助于早期识别。RDC可能提供增量诊断价值，并可作为区分贲门失弛缓症与EGJOO的实用辅助工具。
英文摘要
BACKGROUND AND AIMS: Nonobstructive dysphagia (NOD) is a frequently encountered condition. The spectrum of underlying esophageal motility disorders remains incompletely characterized in Asian populations. We aimed to define the manometric spectrum of NOD, identify predictors of achalasia, and evaluate the diagnostic value of provocative testing.
METHODS: This retrospective multicenter study included adults who underwent high-resolution manometry (HRM) for NOD at two tertiary hospitals in Malaysia from 2014 to 2023. Diagnoses were classified according to Chicago Classification v3.0. Clinical predictors of achalasia were evaluated. The discriminatory performance of rapid drink challenge (RDC)-integrated relaxation pressure (IRP) in differentiating achalasia from non-achalasia was explored.
RESULTS: Among 230 patients (mean age 53.3; 47.0% male), achalasia was identified in 23.9%, esophagogastric junction outflow obstruction (EGJOO) in 17.3%, and ineffective esophageal motility in 24.8%. Weight loss (adjusted OR 2.99, 95% CI 1.25-7.15, p = 0.014), absence of dyspepsia (adjusted OR 0.09, 95% CI 0.02-0.45, p = 0.004), and presence of nausea/vomiting (adjusted OR 3.35, 95% CI 1.34-8.40, p = 0.010) independently predicted achalasia. RDC-IRP demonstrated strong discrimination between achalasia and non-achalasia (AUC 0.894, 95% CI 0.794-0.993, p < 0.001), with an optimal threshold of approximately 18 mmHg (sensitivity 90%, specificity 76.9%).
CONCLUSION: Achalasia constitutes a substantial proportion of patients evaluated for NOD in tertiary care settings. Specific clinical features may aid early recognition. RDC may provide incremental diagnostic value and may serve as a practical adjunctive tool in differentiating achalasia from EGJOO.