蒙古国的高分辨率食管测压：首次全国经验及食管动力障碍的诊断谱

文献信息

中文摘要

背景： 高分辨率食管测压（HREM）是评估食管动力障碍的参考标准；然而，来自低收入和中等收入国家的数据仍然有限。由于HREM在蒙古国最近才可用，本研究旨在通过对转诊模式、食管动力障碍的诊断谱以及与主要动力障碍相关的临床因素进行特征描述，提供蒙古国HREM的首个全面特征分析。方法：我们对在Intermed IUHW医院连续接受HREM的998名成人进行了一项回顾性观察研究，该医院是目前蒙古国唯一提供常规临床HREM服务的中心（n = 998）。测压结果依据芝加哥分类第4.0版进行判读。进行多变量logistic回归作为探索性分析，以确定与主要食管动力障碍独立相关的临床因素。在排除测压显示食管胃交界处流出道梗阻（EGJOO）模式的患者后进行了敏感性分析。结果：总体而言，696名（69.7%）患者因怀疑胃食管反流病或术前抗反流评估而转诊，而302名（30.3%）因怀疑食管动力障碍而转诊。61.9%的患者发现食管动力正常，而无效食管动力是最常见的异常发现（26.9%）。11.2%的患者发现主要食管动力异常，最常见的是测压EGJOO模式（6.4%）和贲门失弛缓症（2.7%）。年龄增加（调整比值比[aOR]每增加10岁为1.35，95% CI 1.12-1.61）、较低体重指数（aOR每kg/m2为0.90，95% CI 0.85-0.95）、吞咽困难（aOR 1.95，95% CI 1.20-3.15）以及因怀疑动力障碍而转诊（aOR 5.47，95% CI 3.22-9.31）与主要食管动力异常独立相关。探索性模型显示出中等区分度（AUC 0.791，95% CI 0.741-0.840）。结论：大多数接受HREM的患者表现为食管动力正常或无效食管动力，而主要动力异常相对不常见。年龄较大、较低体重指数、吞咽困难和因怀疑动力障碍而转诊与主要动力异常独立相关。这些发现提供了蒙古国转诊患者中HREM诊断谱的基线数据，并可能为未来HREM转诊策略的前瞻性研究提供信息。

英文摘要

Background: High-resolution esophageal manometry (HREM) is the reference standard for evaluating esophageal motility disorders; however, data from low- and middle-income countries remain limited. As HREM has only recently become available in Mongolia, this study aimed to provide the first comprehensive characterization of HREM in Mongolia by characterizing referral patterns, the diagnostic spectrum of esophageal motility disorders, and clinical factors associated with major motility disorders. Methods: We conducted a retrospective observational study of 998 consecutive adults who underwent HREM at Intermed IUHW Hospital, the only center currently providing routine clinical HREM services in Mongolia (n = 998). Manometric findings were interpreted according to the Chicago Classification version 4.0. Multivariable logistic regression was performed as an exploratory analysis to identify clinical factors independently associated with major esophageal motility disorders. A sensitivity analysis was performed after excluding patients with a manometric esophagogastric junction outflow obstruction (EGJOO) pattern. Results: Overall, 696 (69.7%) patients were referred for evaluation of suspected gastroesophageal reflux disease or for preoperative anti-reflux assessment, whereas 302 (30.3%) were referred because of suspected esophageal motility disorders. Normal esophageal motility was identified in 61.9% of patients, while ineffective esophageal motility was the most common abnormal finding (26.9%). Major esophageal motility abnormalities were identified in 11.2% of patients, most commonly a manometric EGJOO pattern (6.4%) and achalasia (2.7%). Increasing age (adjusted odds ratio [aOR] 1.35 per 10-year increase, 95% CI 1.12-1.61), lower body mass index (aOR 0.90 per kg/m2, 95% CI 0.85-0.95), dysphagia (aOR 1.95, 95% CI 1.20-3.15), and referral for suspected motility disorders (aOR 5.47, 95% CI 3.22-9.31) were independently associated with major esophageal motility abnormalities. The exploratory model demonstrated moderate discrimination (AUC 0.791, 95% CI 0.741-0.840). Conclusions: Most patients undergoing HREM demonstrated either normal esophageal motility or ineffective esophageal motility, whereas major motility abnormalities were relatively uncommon. Older age, lower body mass index, dysphagia, and referral for suspected motility disorders were independently associated with major motility abnormalities. These findings provide baseline data on the diagnostic spectrum of HREM among referred patients in Mongolia and may inform future prospective studies of HREM referral strategies.