可干预的原发性动力性食管胃结合部流出道梗阻的诊断与管理：欧洲神经胃肠病学与动力学会临床实践更新
Diagnosis and Management of Actionable Primary Motor Esophagogastric Junction Outflow Obstruction: Clinical Practice Update of the European Society of Neurogastroenterology and Motility.
文献信息
| PMID | 42897705 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Pierfrancesco Visaggi |
| 作者单位 | Gastroenterology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy. |
| 期刊 | Neurogastroenterology and motility |
| SCI 分区 | Q2 |
| IF | 3.8 |
| 研究类型 | 指南共识 · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
背景： 原发性动力性食管胃结合部流出道梗阻（EGJOO）是一种食管动力障碍，通过高分辨率测压（HRM）在不存在潜在结构性或机械性梗阻原因的情况下被识别。原发性动力性EGJOO的临床意义、管理和预后仍不确定。本临床实践更新就EGJOO的评估和管理提供专家指导，特别强调确定该病何时为“可干预的”——即可能从下食管括约肌（LES）导向的治疗中获益。
方法： 在欧洲神经胃肠病学与动力学会的认可下，一个由11名成员组成的国际工作组制定了关于EGJOO的建议声明，重点关注可干预的原发性动力性EGJOO的诊断和管理。声明基于现有文献证据制定，并在虚拟会议上展示。每项声明均由工作组投票表决，达到≥80%一致性的声明被纳入为推荐意见。
结果： 共有十二项声明达到一致性阈值。总之，工作组一致认为，可干预的原发性动力性EGJOO应定义为临床症状、特征性HRM模式以及非测压佐证检查（包括内镜、钡餐食管造影和功能性腔道成像探针测压）共存，且不存在继发性原因。可干预的原发性动力性EGJOO患者可根据诊断确信程度接受药物、内镜和/或手术治疗，而无上述特征者不需要LES导向的侵入性干预。
结论： 本临床实践更新代表了基于证据和专家意见的共识，涉及可干预的原发性动力性EGJOO最合适的诊断和治疗检查流程。
英文摘要
BACKGROUND: Primary motor esophagogastric junction outflow obstruction (EGJOO) is an esophageal motility disorder identified by high-resolution manometry (HRM) in the absence of an underlying structural or mechanical cause of obstruction. The clinical significance, management, and prognosis of primary motor EGJOO remain uncertain. This clinical practice update provides expert guidance on the evaluation and management of EGJOO, with particular emphasis on determining when the condition is "actionable"-that is, likely to benefit from lower esophageal sphincter (LES)-directed therapies.
METHODS: With the endorsement of the European Society of Neurogastroenterology and Motility, an 11-member international Working Group developed recommendation statements on EGJOO, focusing on the diagnosis and management of actionable primary motor EGJOO. Statements were developed based on available literature evidence and presented at virtual meetings. Each statement was voted upon by the Working Group, and statements reaching ≥ 80% agreement were included as recommendations.
RESULTS: Twelve statements reached the agreement threshold. In summary, the Working Group agrees that actionable primary motor EGJOO should be defined by the coexistence of clinical symptoms, a characteristic HRM pattern, and non-manometric corroborative tests, including endoscopy, barium esophagogram, and functional lumen imaging probe panometry, in the absence of secondary causes. Patients with actionable primary motor EGJOO may receive medical, endoscopic, and/or surgical treatment, based on level of confidence in the diagnosis, while those without do not require LES-directed invasive intervention.
CONCLUSIONS: This clinical practice update represents an evidence and expert opinion-based consensus on the most appropriate diagnostic and therapeutic workup of actionable primary motor EGJOO.