Analysis of non-obstructive dysphagia with esophageal high-resolution manometry

Abstract

Objective To analyze the distribution and esophageal motility characteristics of patients with non obstructive dysphagia (NOD).Methods From June 2010 to June 2012,ninety seven patients with a sense of obstruction when swallowing were selected and patients with esophageal organic stenosis was excluded through endoscopic examination and upper gastrointestinal radiography.While nine healthy volunteers were recruited as healthy control.High-resolution esophageal manometry was performed with high-resolution multi-channel Netherlands CTD Synectics gastrointestinal function monitoring system (Pcpolygraf polysomnography recording system) and MMS digestive power detection system.The observation parameter included upper esophageal sphincter pressure (UESP),upper esophageal sphincter relaxation rate (UESRR),the length of the lower esophageal sphincter (LESL),lower esophageal sphincter pressure (LESP),intergrated relaxation pressure (IRP),lower esophageal sphincter relaxation rate (LESRR),esophageal subordinate segments pressure and esophageal effective peristalsis ratio.The rank sum test was performed for comparison between groups.Results Among 97 patients with NOD,the percentage of achalasia,nonspecific esophageal motor disorder andgastroesophageal reflux disease (GERD) was 41.2％ (40/97),39.2％ (38/97)and 19.6％(19/97),respectively.Among patients with nonspecific esophageal motor disorder,the percentage of abnormal peristalsis,absent peristalsis,normal pressure and distal esophegesl spasm was 39.5％(15/38),36.8％(14/38),15.8％(6/38) and 7.9％(3/38),respectively.The differences in lESL,LESP,LESRR,esophageal subordinate segments pressure and esophageal effective peristalsis ratio among achalasia,GERD,nonspecific esophageal motor disorder and healthy control were statistically significant (F 6.143,57.490,50.559,10.155 and 22.046,all P＜0.05).LESP oF patients with achalasia was higher than that of healthy control,however LESRR,esophageal subordinate segments pressure and esophageal effective peristalsis ratio were all lower than those of healthy control and the differences were statistically significant (F 2.276,11.113,-8.036 and -14.663,all P＜0.05).LESL and LESP of achalasia were both higher than those of GERD group,LESRR,esophageal subordinate segments pressure and esophageal effective peristalsis ratio were all lower than those of GERD group and the differences were statistically significant (F=4.325,15.983,-19.235,-3.410 and-4.351,all P＜0.05).LESL and LESP of achalasia group both were higher than those of nonspecific esophageal motor disorder group,LESRR and esophageal effective peristalsis ratio were both lower than those of GERD group and the differences were statistically significant (F=2.376,7.668,2.873 and-3.873,all P＜0.05).LESRR of GERDgroup was higher than that of healthy control group,LESL,LESP,esophageal subordinate segments pressure and esophageal effective peristalsis ratio were all lower than those of healthy control group and the differences were statistically significant (F=5.931,-2.483,-14.618,-3.071 and-4.516,all P＜0.05).LESL and LESP of GERD group were both lower than those of nonspecific esophageal motor disorder group,LESRR was higher than that of nonspecific esophageal motor disorder group and the differences were statistically significant (F =--2.113,6.578 and 10.979,all P ＜ 0.05).LESP,LESRR,esophageal subordinate segments pressure and esophageal effective peristalsis ratio of nonspecific esophageal motor disorder group were all lower than those of healthy control group and the differences were statistically significant (F=-6.313,-3.580,-3.511 and-8.150,all P＜0.05).IRP of 40 patients with achalasia were all beyond the normal range.Conclusions NOD mainly included achalasia,nonspecific esophageal motor disorder and GERD.The reduction of effective esophageal peristalsis may be an important pathophysiological mechanism of NOD. Key words: Manometry; Deglutition disorders; Esophageal achalasia; Gastroesophageal reflux