ABSTRACT
Objective To explore the etiologies and characteristics of esophageal motility in patients with non-obstructive dysphagia by esophageal high-resolution manometry (HRM).Methods From November 2011 to August 2015,233 patients with non-obstructive dysphagia diagnosed by HRM were retrospectively analyzed.All the patients received gastroendoscopy to exclude obstructive dysphagia.Results Among 233 patients with non-obstructive dysphagia,there were 160 cases of achalasia,38 cases of nonspecific esophageal motor disorder (13 cases of low amplitude peristalsis or absent peristalsis,seven cases of synchronous contraction or rapid contraction,three cases of distal esophageal spasm,six cases of increased resting upper esophageal sphincter pressure (UESP),three cases of reduced UESP,six cases of lower esophageal sphincter (LES) incomplete relaxation),five cases of gastroesophageal reflux disease,four cases of scleroderma,two cases of Jackhammer esophagus,and 24 cases with normal esophageal motility.Conclusions Achalasia is the most common cause of non-obstructive dysphagia,followed by nonspecific esophageal motor disorder.Esophageal HRM is an important method for the diagnosis of nonobstructive dysphagia,especially for unexplained dysphagia.
ABSTRACT
Objective To investigate the effects of transcutaneous electro acupuncture stimulation (TEA) on esophageal motility of patients with refractory gastroesophageal reflux disease (RGERD) by high resolution manometry (HRM),and to provide a new treatment option for RGERD.Methods From February 2014 to June 2015,a total of 45 patients with RGERD were enrolled.TEA instrument was used for electro acupuncture stimulation at the points of Zusanli and Neiguan.HRM was carried out before and after treatment.The changes of HRM parameters such as lower esophageal sphincter pressure (LESP),distal contractile integral (DCI),and amplitude of 3 cm,7 cm above lower esophageal sphincter (LES),esophageal body velocity and contractile front velocity (CFV) were also compared.The paired-samples t test was performed for statistical analysis.Results According to LESP value,45 patients were divided into low LESP group (10 patients) and normal LESP group (35 patients).According to parameter of esophageal motility function,patients were divided into esophageal dysmotility group (25 patients) and normal esophageal motility group (20 patients).After TEA treatment,the LESP of lower LESP group was (14.83± 4.17) mmHg (1 mmHg =0.133 kPa),which was higher than that before treatment ((9.54 ±2.42) mmHg),and the difference was statistically significant (t=4.92,P=0.001).LESP of esophageal dysmotility group was (19.04±5.91) mmHg,which was higher than that before treatment ((16.20±6.09) mmHg),and the difference was statistically significant (t=4.92,P=0.001).There was no statistically significant difference in LESP of normal LESP group and normal esophageal motility group before and after treatment (both P＞0.05).After treatment,DCI of esophageal dysmotility group was (530.76±215.53) mmHg· cm· s,which was higher than that before treatment ((363.92 ± 279.17) mmHg · cm · s),and the difference was statistically significant (t=2.86,P＜0.05).There was no statistically significant difference in esophageal body velocity,amplitude of 3 cm,7 cm above LES andCFV before and after treatment (all P＞0.05).There was no statistically significant difference in all of the esophageal motility parameters in normal esophageal motility group before and after treatment (all P＞0.05).Conclusion TEA can increase LESP and DCI in RGERD patients with esophageal motility dysfunction,improve contraction of entire esophagus and raise esophageal clearance capacity.