老年人高分辨率测压：功能性吞咽困难模式、贲门失弛缓症亚型及临床预测因素
High-resolution manometry in the elderly: patterns of functional dysphagia, achalasia subtypes, and clinical predictors.
文献信息
| PMID | 42952676 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Deepanjan Dey |
| 作者单位 | Department of Physiology, Armed Forces Medical College, Pune, India. |
| 期刊 | Frontiers in physiology |
| SCI 分区 | Q1 |
| IF | 4.5 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
背景： 老年人的吞咽困难常被归因于衰老，而未进行客观功能检查。我们描述一个连续老年队列的高分辨率测压（HRM）指标及食管动力障碍（EMD）分类，以指导转诊和管理。
方法： 在这项横断面研究中，我们连续纳入176例年龄>65岁、表现为食管性吞咽困难的患者。排除标准：结构性病变、混合性口咽吞咽困难、近期使用质子泵抑制剂、系统性硬化症以及Katz日常生活活动能力评分<6。进行HRM并按芝加哥分类v4.0对吞咽进行分型。我们报告描述性HRM指标，并使用logistic回归识别正常HRM与EMD的独立预测因素。
结果： 正常HRM见于57/176例（32.4%）。贲门失弛缓症（44/176；25%）和无收缩（36/176；20.5%）是最常见的EMD；以II型贲门失弛缓症为主。正常HRM组的下食管括约肌中位基础压力和整合松弛压低于EMD患者（15.3 ± 6.7 mmHg和6.0 ± 4.0 mmHg vs 20.5 ± 23.5 mmHg和11.0 ± 12.9 mmHg）。在多变量分析中，男性性别和较年轻的老年年龄段（66-70岁）与EMD独立相关，而Katz ADL和症状持续时间则不是。年龄与连续HRM指标之间的相关性较弱。
结论： 三分之一有症状的老年人HRM收缩指标正常；贲门失弛缓症和无收缩占大多数病理发现。这些数据支持早期进行功能检查，而不是将吞咽困难仅归因于衰老。建议开展前瞻性多模式研究（panometry/阻抗）以评估非收缩机制并完善转诊流程。
英文摘要
BACKGROUND: Dysphagia in the elderly is often attributed to ageing without objective functional testing. We describe high-resolution manometry (HRM) metrics and esophageal motility disorder (EMD) classification in a consecutive geriatric cohort to inform referral and management.
METHODS: In this cross-sectional study we enrolled 176 consecutive patients aged >65 years presenting with esophageal dysphagia. Exclusions: structural lesions, mixed oropharyngeal dysphagia, recent proton pump inhibitor use, systemic sclerosis and Katz Activities of Daily Living < 6. HRM was performed and swallows classified per Chicago Classification v4.0. We report descriptive HRM metrics using logistic regression to identify independent predictors of normal HRM versus EMD.
RESULTS: Normal HRM was present in 57/176 (32.4%). Achalasia (44/176; 25%) and absent contractility (36/176; 20.5%) were the commonest EMDs; type II achalasia predominated. Median basal lower esophageal sphincter pressure and integrated relaxation pressure were lower in the normal-HRM group (15.3 ± 6.7 mmHg and 6.0 ± 4.0 mmHg) than in patients with EMDs (20.5 ± 23.5 mmHg and 11.0 ± 12.9 mmHg). On multivariable analysis, male sex and younger geriatric age band (66-70 years) were independently associated with EMD while Katz ADL and symptom duration were not. Correlations between age and continuous HRM metrics were weak.
CONCLUSIONS: One-third of symptomatic older adults had normal contraction metrics on HRM; achalasia and absent contractility accounted for most pathologic findings. These data support early functional testing rather than attributing dysphagia to ageing alone. Prospective multimodal studies (panometry/impedance) are recommended to evaluate noncontractile mechanisms and refine referral algorithms.