호두까기 식도와 비효과적 식도 운동 환자에서 Marshmallow 식도조영술의 의의

Abstract

Background/Aims: Ineffective esophageal motility (IEM) and a nutcracker esophagus can lead to hypocontractile dysmotility and hypercontractile dysmotility, respectively. We evaluated patients for the abnormalities of marshmallow esophagography and we compared the esophageal symptoms with the esophageal manometric findings in the patients. Methods: We included total 96 patients; there were 23 patients with IEM, 36 patients with nucracker esophagus, 37 individuals with esophageal symptoms who remained in the the normal esophageal manometric group, and 9 asymptomatic healthy controls. The distal esophageal body pressure and the lower esophageal sphincter pressure were examined with respect to the grade of marshmallow esophagography. Results: The nine healthy volunteers displayed no abnormal marshmallow transit. However, 43.5% of the patients with IEM and 36% of the patients with nutcracker esophagus displayed abnormal marshmallow transit. There was a statistical difference between the healthy volunteer group and those patients with nutcracker esophagus or IEM (p<0.05). Abnormal marshmallow esophagography occurred more frequently for the non-transmitted contraction and the combined type of IEM (non-transmitted contraction and low-amplitude contraction) (p<0.05). However, there was no difference between the distal esophageal pressure and the grade of the marshmallow esophagography. Furthermore, nutcracker esophagus did not display any significant relationship with the distal esophageal pressure and the lower esophageal sphincter pressure with respect to the grade of the marshmallow esophagography. Conclusions: Although the measurement of the distal esophageal pressure and the lower esophageal sphincter pressure did not provide statistically significance for the marshmallow transit in IEM and the nutcracker esophagus, the non-transmitted contraction and the combined type provided a statistically significant result for IEM.