Akalazyalı olgularda alt özofagus sfinkter basınç akım metriklerinin ve tedaviye yanıtının retrospektif incelenmesi
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Dosyalar
Tarih
2020
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Yayıncı
Ege Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
maç: İmpedans manometri kullanımı ile elde edilen basınç-akım analizi, yutma fizyopatolojisinin anlaşılmasında, rutinde kullanılan yüksek çözünürlüklü manometriye kıyasla çok daha ayrıntılı veri sağlayan, yeni bir yöntemdir. Çalışmamızda akalazyalı olgularda, basınç-akım metriklerinin özofagus motor fonksiyonlarını değerlendirmedeki yeri belirlenmeye çalışılmıştır. Bunun için öncelikle akalazya olgularının manometrik incelemeleri yapılıp, basınç-akım metrikleri kullanılarak analiz edilmiş, bu metriklerin akalazya hastalığını tespit etme ve gruplandırma gücü, sağlıklı kontrollere göre karşılaştırarak incelenmiştir. Ayrıca akalazya olgularında bir alt grupta tedavi öncesi ve sonrası aynı incelemeler yapılarak karşılaştırmalar yapılmıştır. Gereç ve Yöntem: Ege Üniversitesi Tıp Fakültesi Gastroenteroloji Kliniği'ne başvuran yeni tanı ve tedavi sonrası akalazya hastalarından elde edilen manometri verileri ile sağlıklı gönüllü havuzundan elde edilen manometri verileri, basınç-akım analizi yapılıp, Swallow Gateway veri tabanında değerlendirilmiştir. Sonrasında iki grubun Swallow Gateway verileri (PCI, DCI, IRP, IR, DPA, DPE, CSI, RP, PFI) karşılaştırılmıştır. Veriler istatistiksel olarak SPSS programında; Mann-Whitney U testi, Ki-kare testi ve Spearman korelasyon analizi kullanılarak değerlendirilmiştir. Bulgular: Bu çalışmada, yaş ortalaması 52±14,8 olan tedavi naif akalazya hastaları [n:21 %62(13) erkek, %38 (8) kadın ] ile yaş ortalaması 38±9,1 olan sağlıklı gönüllü [n:14 %21,4 (3) erkek, %78,6 (11) kadın] grubun basınç akım analizlerinden elde edilen metrikler karşılaştırıldı. Bu iki grubun yaş ortalamaları (p:0,08) ve cinsiyet dağılımı (p:0,0042) istatistiksel anlamlı bulundu. PCI, IRP, DPA, DPE, RP, PFI metrikleri istatistiksel anlamlı bulunmuştur. Bu analizde Eckardt skoru, istirahat basıncı, DCI, IRP, DPE metrikleri istatistiki anlamlı bulunmuştur. Sonuç: Akım metriklerinin, basınç metrikleri ile korele olduğu görülmüştür. DPE tedavi naive hastalar ile sağlıklılar arasında dramatik fark göstermiş ve tedavi sonrası incelenen subgruptada anlamlı düşmüştür. Bundan dolayı DPE' nin tedavi sonrasında semptomları süren hastalarda önemli bir belirteç olabileceğini düşündürmüştür. PFI olarak tedavi öncesi ve sonrası gruplar arasında dramatik fark saptanmıştır. Bu nedenle tip 3 akalazya grubunda gerek diagnostik, gerek terapotik başarıyı ölçmede anlam taşıyabilir. RP' nin hastalarda, sağlıklılardan yüksek oluşu bu metriğin sadece tip 3 akalazya grubunda hesaplanmasından dolayı, tanı ve tedavi başarısında anlam taşıyabileceğini düşündürmüştür. Bu metriğin daha geniş hasta gruplarıyla çalışması gerekir. Metriklerin çoğu, tip1 ve tip 2 akalazyada ölçülemediği için basınç akım analizinin tanı ve prognostik değeri sınırlı kalmaktadır ancak PFI, RP, DPE nin anlamlı olabileceği düşünülmüştür. Tip 3 akalazya tedavisi en zor olan gruptur bu grubun tedavi başarısını ölçmede PFI ve RP nin yol gösterebileceği düşünülmüştür.
Aim: The pressure-flow analysis obtained by the use of impedance manometry is a new method of understanding swallowing physiopathology, providing much more detailed data than the high resolution manometry used in routine. In our study, we tried to determine the place of pressure-flow metrics in evaluating esophagus motor functions in patients with achalasia. For this purpose, firstly, the manometric examinations of the achalasia cases were analyzed and analyzed by using pressure-flow metrics, and the power of these metrics to detect and group achalasia disease was compared according to healthy controls. In addition, comparisons were made in a subset of achalasia cases before and after treatment. Materials and Methods: After the new diagnosis and treatment applied to Ege University Faculty of Medicine Gastroenterology Clinic, the manometry data obtained from the achalasia patients and the manometry data obtained from the healthy volunteer pool were analyzed in the Swallow Gateway database. Afterwards, Swallow Gateway data (PCI, DCI, IRP, IR, DPA, DPE, CSI, RP, PFI) of the two groups were compared. The data were analyzed statistically by using Mann-Whitney U test, Chi-square test and Spearman correlation analysis in SPSS program. Results: In this study, naive achalasia patients with a mean age of 52 ± 14.8 [n: 21 62% (13) men, 38% (8) women] and healthy volunteers with mean age 38 ± 9.1 [n: 14% 21 The metrics obtained from the pressure flow analysis of 4 (3) male, 78.6% (11) female] groups were compared. The mean age (p: 0.08) and gender distribution (p: 0.0042) of these two groups were found statistically significant. PCI, IRP, DPA, DPE, RP, PFI metrics were statistically significant. In this analysis, Eckardt score, resting pressure, DCI, IRP, DPE metrics were found statistically significant. Conclusion: Flow metrics were found to be correlated with pressure metrics. DPE treatment showed a dramatic difference between naive patients and healthy subjects and decreased significantly in the subgroup examined after treatment. Therefore, DPE suggested that it may be an important marker in patients whose symptoms persist after treatment. As PFI, a dramatic difference was found between the groups before and after treatment. Therefore, it can be meaningful in measuring diagnostic and therapeutic success in the type 3 achalasia group. The fact that RP is higher in patients than healthy suggests that this metric can only be meaningful in diagnosis and treatment success since it is calculated only in the type 3 achalasia group. This metric needs to work with larger patient groups. Since most of the metrics cannot be measured in type1 and type 2 achalasia, the diagnostic and prognostic value of pressure flow analysis remains limited, but PFI, RP, DPE are thought to be significant. Type 3 achalasia is the most difficult group to treat. It was thought that PFI and RP could guide the success of this group.
Aim: The pressure-flow analysis obtained by the use of impedance manometry is a new method of understanding swallowing physiopathology, providing much more detailed data than the high resolution manometry used in routine. In our study, we tried to determine the place of pressure-flow metrics in evaluating esophagus motor functions in patients with achalasia. For this purpose, firstly, the manometric examinations of the achalasia cases were analyzed and analyzed by using pressure-flow metrics, and the power of these metrics to detect and group achalasia disease was compared according to healthy controls. In addition, comparisons were made in a subset of achalasia cases before and after treatment. Materials and Methods: After the new diagnosis and treatment applied to Ege University Faculty of Medicine Gastroenterology Clinic, the manometry data obtained from the achalasia patients and the manometry data obtained from the healthy volunteer pool were analyzed in the Swallow Gateway database. Afterwards, Swallow Gateway data (PCI, DCI, IRP, IR, DPA, DPE, CSI, RP, PFI) of the two groups were compared. The data were analyzed statistically by using Mann-Whitney U test, Chi-square test and Spearman correlation analysis in SPSS program. Results: In this study, naive achalasia patients with a mean age of 52 ± 14.8 [n: 21 62% (13) men, 38% (8) women] and healthy volunteers with mean age 38 ± 9.1 [n: 14% 21 The metrics obtained from the pressure flow analysis of 4 (3) male, 78.6% (11) female] groups were compared. The mean age (p: 0.08) and gender distribution (p: 0.0042) of these two groups were found statistically significant. PCI, IRP, DPA, DPE, RP, PFI metrics were statistically significant. In this analysis, Eckardt score, resting pressure, DCI, IRP, DPE metrics were found statistically significant. Conclusion: Flow metrics were found to be correlated with pressure metrics. DPE treatment showed a dramatic difference between naive patients and healthy subjects and decreased significantly in the subgroup examined after treatment. Therefore, DPE suggested that it may be an important marker in patients whose symptoms persist after treatment. As PFI, a dramatic difference was found between the groups before and after treatment. Therefore, it can be meaningful in measuring diagnostic and therapeutic success in the type 3 achalasia group. The fact that RP is higher in patients than healthy suggests that this metric can only be meaningful in diagnosis and treatment success since it is calculated only in the type 3 achalasia group. This metric needs to work with larger patient groups. Since most of the metrics cannot be measured in type1 and type 2 achalasia, the diagnostic and prognostic value of pressure flow analysis remains limited, but PFI, RP, DPE are thought to be significant. Type 3 achalasia is the most difficult group to treat. It was thought that PFI and RP could guide the success of this group.
