OBJECTIVES Symptoms are inconsistently associated with esophageal motor findings on high-resolution manometry (HRM). We aimed to evaluate predictors of dysphagia severity, including esophageal hypervigilance and visceral anxiety, among patients evaluated with HRM. METHODS Adult patients undergoing HRM at 4 academic medical centers (United States and France) were prospectively evaluated. HRM was completed and analyzed per the Chicago Classification v3.0. Validated symptom scores, including the Brief Esophageal Dysphagia Questionnaire and Esophageal Hypervigilance and Anxiety Scale, were completed at the time of HRM. RESULTS Two hundred thirty-six patients, aged 18-85 (mean 53) years, 65% female, were included. Approximately 59 (25%) patients had a major motor disorder on HRM: 19 achalasia, 24 esophagogastric junction outflow obstruction, 12 absent contractility, and 4 jackhammer. Approximately 177 (75%) patients did not have a major motor disorder: 71 ineffective esophageal motility and 106 normal motility. Having a major motor disorder was a significant predictor of dysphagia severity (Radj = 0.049, P < 0.001), but the Esophageal Hypervigilance and Anxiety Scale score carried a predictive relationship of Brief Esophageal Dysphagia Questionnaire that was 2-fold higher than having a major motor disorder: Radj = 0.118 (P < 0.001). This finding remained when evaluated by the major motor disorder group. HRM metrics were nonsignificant. DISCUSSION In a prospective, international multicenter study, we found that esophageal hypervigilance and visceral anxiety were the strongest predictors of dysphagia severity among patients evaluated with HRM. Thus, an assessment of esophageal hypervigilance and visceral anxiety is important to incorporate when evaluating symptom severity in clinical practice and research studies.

中文翻译：

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食管高度警惕和内脏焦虑是高分辨率食管测压评估患者症状严重程度的原因


目的 症状与高分辨率测压 (HRM) 的食管运动结果的相关性不一致。我们的目的是在接受 HRM 评估的患者中评估吞咽困难严重程度的预测因素，包括食管过度警觉和内脏焦虑。方法 对在 4 个学术医疗中心（美国和法国）接受 HRM 的成年患者进行前瞻性评估。根据芝加哥分类 v3.0 完成和分析 HRM。在 HRM 时完成了经过验证的症状评分，包括简短的食管吞咽困难问卷和食管高度警惕和焦虑量表。结果 纳入 236 名患者，年龄 18-85（平均 53）岁，其中 65% 为女性。大约 59 名 (25%) 患者在 HRM 上有主要运动障碍：19 名贲门失弛缓症、24 名食管胃交界处流出梗阻、12 名缺乏收缩力和 4 名手提钻。大约 177 名 (75%) 患者没有主要运动障碍：71 名患者食管运动无效，106 名患者食管运动正常。患有主要运动障碍是吞咽困难严重程度的重要预测因子（Radj = 0.049，P < 0.001），但食管高度警惕和焦虑量表评分与食管吞咽困难问卷的预测关系比患有主要运动障碍高 2 倍无序：Radj = 0.118 (P < 0.001)。当主要运动障碍组进行评估时，这一发现仍然存在。人力资源管理指标并不显着。讨论 在一项前瞻性国际多中心研究中，我们发现食管高度警惕和内脏焦虑是用 HRM 评估的患者吞咽困难严重程度的最强预测因素。 因此，在临床实践和研究中评估症状严重程度时，对食管过度警觉和内脏焦虑的评估非常重要。