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Objective To analyze the effects of different food bolus on esophageal motility in patients with non-obstructive esophageal dyshagia by high-resolution esophageal manometry.Methods From March 2014 to June 2015,48 patients with non-obstructive esophageal dysphagia and 12 healthy volunteers (healthy control group) were enrolled.High-resolution manometry was tested when swallowing liquid food,semisolid food and solid food.The lower esophageal sphincter pressure (LESP),4 second integrated relaxation pressure (4 s IRP),distal contractile integral (DCI),distal latency (DL),and breaks were analyzed.T test was performed for statistical analysis.Results According to the 2014 Chicago classification standard,among 48 patients with dysphagia,esophageal dysmotility was diagnosed in 35 patients (72.9％),while 13 patients (27.1％) had normal esophageal motility,and the most common type of esophageal motility disorder was ineffective esophageal motility (31.2％,15/48).The LESP of the healthy control group was (10.85±3.75) mmHg (1 mmHg=0.133 kPa) and 4 s IRP was (1.90±0.84) mmHg.The LESP of dysphagia group was (12.20 ±8.93) mmHg and 4 s IRP was (3.25± 1.02) mmHg.There was no significant difference in LESP and 4 s IRP between two groups (both P＞0.05).The DCIs of liq(u)id swallows,semisolid swallows and solid swallows of healthy control group were (589.00±292.90),(690.17±52.41) and (808.00±448.53) mmHg · s · cm,respectively,which were significantly lower than those of complete normal group in Chicago classification ((1 346.62 ± 244.83),(1 542.46±231.19) and (1 890.31±363.26) mmHg · s · cm;t=4.76,4.68 and 3.79;all P=0.001).The DL of solid swallows of healthy control group was (7.72± 1.15) s,which was significantly lower than that of complete normal group in Chicago classification ((9.00±1.23) s;t=2.61,P=0.021).The breaks of liquid swallows,semisolid swallows and solid swallows of healthy control group were (2.33 ±1.74),(2.37±1.72) and (1.53± 1.22) cm,respectively,which were higher than those of complete normal group in Chicago classification ((0.58±0.48),(0.52±0.47) and (0.85±0.53) cm),and the differences were statistically significant (t =3.02,3.68 and 2.54,all P ＜ 0.05).Conclusions The most common type of esophageal motility disorder in patients with non-obstructive esophageal dysphagia is ineffective esophageal molitity.When swallowing food,the patients with dysphagia but normal results of esophageal manometry according to Chicago classification require more strength of the esophagus,more complete contraction and longer peristaltic time to swallow food bolus.
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Introducción: La disfagia puede ser a nivel orofaríngeo o esofágico debido a trastornos estructurales o funcionales. Su abordaje diagnóstico y tratamiento evita la desnutrición y el riesgo de aspiración. Objetivo: reportar la experiencia en la evaluación diagnóstica y tratamiento en niños con disfagia orofaríngea y esofágica. Pacientes y método: estudio descriptivo y transversal, de 49 niños con disfagia, durante dos años. Protocolo de estudio: historia clínica, patologías asociadas, estudio radiológico, endoscopia, nasolaringoscopia-videodeglutoscopia, terapia deglutoria, videofluoroscopia, manometría y ph-metría esofágica y tratamiento indicado. Resultados: 20(40,82%) hembras y 29(59,18%) varones. Edad promedio 2,56 años (rango: 1m-16 años). El 46,93% presentó trastornos neurológicos como patología asociada. El 65,31% con disfagia a sólidos y 34,69% a líquidos, otros síntomas: vómitos, regurgitaciones y reflujo faringo-nasal. Posterior a la evaluación y estudios se encontró: disfagia orofaríngea 25/49(51,02%), de origen funcional en 22/25(88%) y mecánica 3(12%); disfagia esofágica 13/49(26,53%), mecánica en 1/13(7,69%) y funcional en 12/13(92,30%) de los cuales 6 con dismotilidad inespecífica y 4 asociada a esofagitis; disfagia mixta 11(22,44%). Evaluación nutricional fue requerida en 65,30%, se indicó nutrición por sonda de alimentación en 21 niños, por gastrostomía endoscópica en 4 y cambio en la consistencia de los alimentos en 7. Dilatación esofágica por estenosis congénita en un caso y por acalasia esofágica en 2. Terapia deglutoria en 71,42%. Conclusiones: la evaluación integral del niño con disfagia orofaríngea y esofágica es fundamental para identificar la causa e indicar el tratamiento específico con apoyo nutricional, procedimientos endoscópicos y terapia deglutoria.
Introduction: Dysphagia can be oropharyngeal or esophageal level due to structural or functional disorders. Its diagnosis and treatment approach prevents malnutrition and the risk of aspiration. Objective: To report our experience in the diagnostic evaluation and treatment for children with oropharyngeal and esophageal dysphagia. Patients and methods: Descriptive, cross-sectional, 49 children with dysphagia, for two years. Study protocol: clinical history, associated diseases, radiographs, endoscopy, Nasolaryngoscopy-videodeglutoscopia therapy, swallowing, videofl uoroscopy, manometry and esophageal pHmetry and appropriate treatment. Results: 20 (40.82%) females and 29 (59.18%) males. Average age 2.56 years (range: 1m-16 years). The 46.93% had neurological disorders and associated diseases. The 65.31% with dysphagia to solids and 34.69% for liquids, other symptoms: vomiting, regurgitation and nasal pharyngeal reflux. After the evaluation and studies found: Oropharyngeal Dysphagia 25/49 (51.02%) of functional origin in 22/25 (88%) and mechanical 3 (12%) Esophageal Dysphagia 13/49 (26.53% ) mechanical 1/13 (7.69%) and functional in 12/13 (92.30%) of which 6 and 4 with dysmotility associated nonspecifi c oesophagitis Mixed Dysphagia 11 (22.44%). Nutritional assessment was required to 65.30%, is indicated feeding tube 21 feeding children endoscopic gastrostomy 4 and change in the consistency of food at 7. Dilatation Congenital esophageal stenosis in one case and two esophageal achalasia. Swallowing therapy in 71.42%. Conclusions: The evaluation of the child with oropharyngeal and esophageal dysphagia is essential to identify the cause and indicate the specifi c treatment with nutritional support and therapeutic endoscopic procedures swallowing.