Clinical features and its pathophysiology of patients with esophageal hypertensive peristalsis based on esophageal high resolution manometry

Abstract

Objective To analyze the clinical features, esophageal motility characteristics and pathophysiological significance of patients with esophageal hypertensive peristalsis. Methods From January 2012 to April 2015, 543 patients with upper gastrointestinal symptoms who received esophageal high resolution manometry (HRM) were retrospectively analyzed. Patients with esophageal hypertensive peristalsis were enrolled. At the same time, 17 healthy volunteers were also enrolled. All subjects received a questionnaire survey of dysphagia. According to the results of HRM, patients were divided into Jackhammer esophagus and other kindsot hypertensive peristalsis esophagus (hypertensive peristalsis at esophageal body, normal lower esophageal sphincter (LES) relaxation, however distant contraction integration (DCI) not meeting the criteria of Jackhammer esophagus according to Chicago classification). Esophageal motility of them was also analyzed. Part of the patients underwent 24 h pH-impedance monitoring.Mann-Whitney U test, Fisher exact test and Spearman test were applied for statistical analysis. Results Among the 543 patients, 64 (11.8%) had hypertensive peristalsis at esophageal body. Ten (15.6%) had Jackhammer esophagus, and the others (43 cases, 67.2%) had hypertensive peristalsis esophagus. Five cases presented esophageal spasm in ten patients with Jackhammer esophagus in upper gastrointestinal angiography. And the incidence of esophageal spasm in other hypertensive peristalsis esophagus group was 30.2% (13/43). No statistically significant difference was found between these two groups (P>0.05). Except for the difference in amplitude of esophgeal peristalsis, there was no significant difference in the clinical symptoms and LES functions between patients with Jackhammer esophagus and patients with other kinds of hypertensive peristalsis esophagus (all P>0.05). The dysphagia questionnaire investigations were completed in 34 patients. There were negative correlations between frequency of solid food dysphagia and esophageal DCI, the esophageal peristaltic amplitude at 3 cm above LES, the esophageal peristaltic amplitude at 3 cm to 7 cm above LES (r=-0.445, P=0.008; r=-0.354, P=0.040, r=-0.459, P=0.006). Negative correlations were found between severity of solid food dysphagia and average DCI, amplitude 3 cm to 7 cm above LES (r=-0.349, P=0.043; r=-0.400, P=0.019). Among the 17 patients with 24 h esophageal pH-impedance monitoring, ten had pathological gastroesophageal reflux. Conclusions Among patients with upper gastrointestinal syndromes, patients with hypertensive peristalsis at esophageal body are not uncommon. Except for the difference in amplitude of esophgeal peristalsis, there is no significant difference in clinical and esophageal motility features between Jackhammer esophagus and other kinds of hypertensive peristalsis esophagus, so maybe they are different degrees of esophageal motility disorder of the same. Key words: Esophagus; Peristalsis; Manometry; Pathology, clinical