芝加哥分类v4.0定义的无效应食管运动在嗜酸性食管炎中识别出具有临床和内镜相关性的表型
Ineffective Esophageal Motility Defined by Chicago Classification v4.0 Identifies a Clinically and Endoscopically Relevant Phenotype in Eosinophilic Esophagitis.
文献信息
| PMID | 42755394 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Mentore Ribolsi |
| 作者单位 | Department of Digestive Diseases, Campus Bio Medico University of Rome, Roma, Italy. |
| 期刊 | Neurogastroenterology and motility |
| 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： 食管运动异常可能导致嗜酸性食管炎（EoE）的症状，但大多数现有证据基于芝加哥分类第3.0版（CCv3.0）。
目的： 我们评估了根据CCv4.0定义的运动障碍在EoE患者中的患病率和临床相关性。
方法： 我们回顾性连续纳入2016年至2024年间在四家意大利三级中心接受上消化道内镜和高分辨率测压的未经治疗的EoE患者。测压描记根据CCv3.0和CCv4.0重新分析。评估了无效应食管运动（IEM）与症状、诊断延迟和内镜参考系统（EREFS）发现之间的关联。
结果： 共106例患者纳入分析。CCv4.0识别出15例（14.2%）IEM，而使用CCv3.0为29例（27.4%），正常运动从60.4%增加到75.5%。CCv4.0定义的IEM患者中有14/15发生食物嵌塞。CCv4.0定义的IEM与食物嵌塞独立相关（OR 6.92，95% CI 1.37-34.94；p=0.019），而CCv3.0定义的IEM则无此关联。根据CCv4.0，IEM与炎症性（93.3% vs. 57.5%；OR 10.35，95% CI 1.30-82.55；p=0.008）和纤维狭窄性内镜表型（73.3% vs. 35.0%；OR 5.11，95% CI 1.49-17.53；p=0.009）均强烈相关，而使用CCv3.0未观察到显著关联。
结论： CCv4.0降低了IEM的患病率，并在EoE中识别出更具临床和内镜相关性的低动力表型，其特征是与食物嵌塞以及炎症性和纤维狭窄性内镜特征均强烈相关。这些发现支持更严格的CCv4.0标准在EoE功能表型分型中的临床相关性。
英文摘要
BACKGROUNDS: Esophageal motility abnormalities may contribute to symptoms in eosinophilic esophagitis (EoE), but most available evidence is based on Chicago Classification version 3.0 (CCv3.0).
AIM: We evaluated the prevalence and clinical relevance of motility disorders defined according to CCv4.0 in patients with EoE.
METHODS: We retrospectively included consecutive untreated patients with EoE who underwent upper endoscopy and high-resolution manometry at four Italian tertiary centers between 2016 and 2024. Manometric tracings were reanalyzed according to both CCv3.0 and CCv4.0. Associations between ineffective esophageal motility (IEM), symptoms, diagnostic delay, and Endoscopic Reference System (EREFS) findings were assessed.
RESULTS: 106 patients were included in the analysis. CCv4.0 identified IEM in 15 patients (14.2%), compared with 29 (27.4%) using CCv3.0, while normal motility increased from 60.4% to 75.5%. Food impaction occurred in 14/15 patients with CCv4.0-defined IEM. CCv4.0-defined IEM was independently associated with food impaction (OR 6.92, 95% CI 1.37-34.94; p = 0.019), whereas CCv3.0-defined IEM was not. According to CCv4.0, IEM was strongly associated with both inflammatory (93.3% vs. 57.5%; OR 10.35, 95% CI 1.30-82.55; p = 0.008) and fibrostenotic endoscopic phenotypes (73.3% vs. 35.0%; OR 5.11, 95% CI 1.49-17.53; p = 0.009), whereas no significant associations were observed using CCv3.0.
CONCLUSIONS: CCv4.0 reduces the prevalence of IEM and identifies a more clinically and endoscopically relevant hypomotility phenotype in EoE, characterized by a strong association with food impaction and both inflammatory and fibrostenotic endoscopic features. These findings support the clinical relevance of the more stringent CCv4.0 criteria for functional phenotyping in EoE.