인두종괴감 및 연하장애 환자의 식도기능검사

Abstract

Objectives: The globus sensation and dysphagia are common symptoms originated from esophagus in the absence of organic lesions, Although the exact mechanism of these symptoms remains unknown, it is believed to be related to multiple etiopathogenesis. However, many of the results are controversial. So in this study, the relationship of esophageal motility disorder, gastroesophageal reflux and psychic disturbances were evaluated in patients with globus sensation or dysphagia. Methods: In 66 patients with globus sense and 23 patients with dysphagia, esophagogastroduodenoscopy, esophageal manometry, 24-hour esophageal pH monitoring and psychiatric evaluation(M.M.P.I.) were done. Results: 1) In patients with globus sense, forty seven among sixty six patients(71.2%) demonstrated motility abnormalities in esophageal manometry. Among the abnormalities, the most frequent finding was a nonspecific esophageal motility disorder(31.8%). 24- hour pH monitoring showed abnormal acid reflux in 5/35(14.3%) of patients. Hiatal hernia[12/43 (27.9%)] was the most common finding in esophagogastroduodenoscopy, and reflux esophagitis[9/43 (20.9%)] was the second most. When combining the results of endoscopy findings and 24-hour pH monitoring data, some signs of gastroesophageal reflux were demonstrated in 11/54(20.496) of patients. Psychiatric evaluation(M.M.P.I) was done in seven patients, and the patients showed hypochondriasis, a nxiety and depression tendency. 2) In patients with dysphagia, twenty one among twenty three patients(91,3%) showed motility abnormalities in esophageal manometry. Among the abnormalities, the most frequent finding was a non- specific esophageal motility disorder(39.1%), 24-hour pH monitoring showed abnormal acid reflux in 1/7 (14.3%) of patients. Reflux esophagitis[6/17 (35.3Yo)] was the most common finding in esophagogastroduodenoscopy, and hiatal hernia[3/17 (17.6%)] was the next. When combining the results of endoscopy findings and 24-hour pH monitoring data, some signs of gastroesophageal reflux were demonstrated in 6/17(35.3%) of patients, Psychiatric evaluation (M.M.P.I.) was done in five patients, and the patients showed hypochondriasis, depression and introver sion tendency. Conclusion: From the results obtained, it can be suggested that globus sensation and dysphagia have multiple etiologies. Abnormal esophageal motility findings were commonly found. Psychic disturbances may play a role in its etiopathogenesis. Therefore, esophagogastroduodenoscopy, esophageal manometry, 24-hour pH monitoring and, if needed, psychiatric evaluation should be included in evaluating globus sense or dysphagia. Furthermore, the treatment should be directed toward abnormal results of these evaluation.