The primary function of the esophagus is to facilitate bolus transport to the stomach. High-resolution manometry assesses the functions of esophageal motility, but not the clearance of bolus transit through the esophagus. The development of combined multichannel intraluminal impedance and manometry (MII-EM) has enabled simultaneous measurement of bolus transport and manometry. This study investigated the effects of bolus transit on esophageal motility disorders and its effect on the quality of life of patients with dysphagia. Methods A total of 810 wet swallows were reviewed and analyzed in 81 patients with dysphagia who underwent MII-EM. Incomplete bolus clearance (IBC) was defined based on impedance measurement. IBC was classified into four types (A: normal, B: incomplete clearance in the upper esophagus, C: incomplete clearance in the lower esophagus, D: incomplete clearance of the whole esophagus), and was also evaluated according to the appearance rate of complete bolus transit. Then, the clinical significance of IBC was determined by our previously validated dysphagia symptom score and the SF8 quality of life instrument (physical component summary and mental component summary). Results There were 16 cases of esophageal achalasia (Ach), 9 of esophagogastric junction outflow obstruction (EGJOO), 8 of distal esophageal spasm (DES), 7 of Jackhammer esophagus (JE), 2 of absent contractility (AC), 10 of ineffective esophageal motility (IEM) and 29 normal cases. The figure shows the breakdown of IBC for each disorder. Complete bolus transit was found in 27.8% in EGJOO, 52.5% in DES, 14.2% in JE, 4.0% in IEM, and 83.3% in normal; no CBT was found in Ach and AC. Patients with IBC had significantly higher dysphagia symptom scores (p < 0.05) and lower mental component summaries (p < 0.05) than those without. Conclusion Patients with dysphagia with esophageal dysmotility were classified into two groups: those with and without IBC. Assessment of bolus transport is an important clinical marker for patients with dysphagia, because those with IBC had a significantly higher dysphagia symptom scores and impaired quality of life.

中文翻译：

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153 吞咽困难患者推注清除不完全的临床意义

食道的主要功能是促进食团向胃的输送。高分辨率测压法评估食道运动的功能，但不评估食团通过食道的清除率。联合多通道管腔内阻抗和测压法 (MII-EM) 的发展使得能够同时测量推注运输和测压法。本研究调查了食团转运对食管动力障碍的影响及其对吞咽困难患者生活质量的影响。方法对81例接受MII-EM的吞咽困难患者的810个湿吞咽进行回顾和分析。基于阻抗测量定义不完全推注清除 (IBC)。IBC分为四种类型（A：正常，B：食管上段清除不完全，C：食管下段不完全清除，D：整个食管的不完全清除），也根据完全食团通过的出现率进行评价。然后，IBC 的临床意义由我们先前验证的吞咽困难症状评分和 SF8 生活质量工具（身体成分总结和心理成分总结）确定。结果食管贲门失弛缓症（Ach）16例，食管胃交界处流出道梗阻（EGJOO）9例，食管远端痉挛（DES）8例，手提钻食管（JE）7例，无收缩力（AC）2例，无效10例食管动力（IEM）和29例正常病例。该图显示了每种疾病的 IBC 细分。EGJOO 中 27.8%、DES 中 52.5%、JE 中 14.2%、IEM 中 4.0% 和正常中 83.3% 中发现了完全推注；在 Ach 和 AC 中未发现 CBT。与没有 IBC 的患者相比，IBC 患者的吞咽困难症状评分显着更高（p < 0.05）和精神成分总结更低（p < 0.05）。结论 伴有食管动力障碍的吞咽困难患者分为两组：伴IBC和不伴IBC。推注运输评估是吞咽困难患者的重要临床标志，因为 IBC 患者吞咽困难症状评分显着较高，生活质量受损。