頭頸部領域および食道領域の各種症状に対する食道運動機能の関与について : High Resolution Manometry を用いた検討

頭頸部領域および食道領域における各種症状に対する食道運動機能の関与を検討した.2007年9月から2012年6月までに,咽喉頭異常感などの頭頸部領域の症状および嚥下困難感,胸痛,胸やけなどの食道領域に関連した症状を主訴に,当科を受診した261例(男性138例,女性123例,平均年齢56.8±17.1才)を対象とし,健康関連QOL(Health Related Quality of Life: HRQL)の測定と食道内圧検査を施行した.健康関連QOLの検討では,咽喉頭違和感,嚥下困難感,胸やけ等の各症状を訴えた患者で,身体的QOL,精神的QOL を表すPCS(physical component summary)あるいはMCS(mental component summary)が低下し,健常者と比較して有意にQOLの低下を認めた.食道内圧検査による食道運動機能異常は,全対象患者中62.0%に認めた.各症状別に食道運動機能障害の内訳を見ると,咽喉頭違和感ではIEM(ineffective esophageal motility)(31.8%),嚥下困難感は食道アカラシア(56.6%),喉のつかえ感は食道アカラシア(35.5%),胸やけはIEM(39.4%),胸痛は食道アカラシア(50.0%),噫気はIEM(50.0%)を最も多く認めた.咽喉頭違和感,嚥下困難感,喉のつかえ感,胸やけ,胸痛などの頭頚部および食道症状を有するものの,器質的疾患を認めない患者のQOLは障害されており,その病態の一つとして食道運動機能異常の存在を念頭に置き,診療にあたることが重要である.There are many cases of patients presenting at the hospital complaining of dysphagia or chest pain. At that time organic diseases are not always detected in these patients;previously several studies showed esophageal motility dysfunction was one of the important factors in the development of these symptoms. However, there have been few reports investigating the relationship between esophageal motility dysfunction and these symptoms. Between September 2007 and June 2012, 216 patients (138 men,123 women;mean age 56.8±17.1 years old) were admitted complaining of the following symptoms:dysphagia, globus sensation, or heart burn and non-cardiac chest pain,but without any organic diseases related symptoms. They all underwent high-resolution esophageal manometry (HRM) and completed a questionnaire regarding their health-related quality of life (HRQOL). The aim of this study was to evaluate the relationship between these symptoms and esophageal motility dysfunction and QOL. In our series, 62% of patients with non-obstructive dysphagia, globus sensation, heartburn and unexplained (non-cardiac) chest pain have an esophageal motility disorder (Achalasia 31.5%, IEM 26.4%, Diffuse esophageal spasm 4.6%;nutcracker esophagus 2.8% and Impaired ECJ relaxation 0.5%). SF-8 score of PCS(Physical Component Summary) in all of the symptoms were significantly lower in comparison with the matched healthy control. SF-8 score of MCS(Mental Component Summary) with globus sensation and esophageal dysphagia were significantly lower in comparison with the matched healthy control. The patients complaining of several symptoms located in the pharynx or esophagus have impaired quality of life and esophageal motility dysfunctions.It is important to consider these issues while examining these patients

川崎医科大学附属病院におけるバルーン小腸内視鏡検査の現状 : 325症例の解析結果を含めて

バルーン小腸内視鏡(balloon assisted endoscopy; BAE)は,従来困難であった小腸の検査・治療に有用な検査法である.当院では,2004年にダブルバルーン小腸内視鏡(double balloon endoscopy; DBE)を導入し,2012年6月現在,234症例(延べ325症例;シングルバルーン小腸内視鏡[single balloon endoscopy; SBE]2例を含む)経験した.症例の内訳は,男性127例,女性107例で,平均年齢は62.6歳であった.主訴は,原因不明の消化管出血(obscure gastrointestinal bleeding; OGIB)症例が143例(61.1%)と最多であった.基礎疾患は心血管障害47例(20.1%)が最多で,抗血小板・抗凝固療法を施行している症例は53例(22.6%)にみられた.経口的アプローチは325症例中158例で,経肛門的アプローチは167例,経口的,経肛門的アプローチを両方施行された症例は56例あった.病変は78例(24.0%)に検出され,その内訳は,びらん及び潰瘍性病変23例(29.5%),腫瘍性病変22例(28.2%),血管性病変21例(26.9%)であった.また,外科的切除,内視鏡的止血術等の治療を58例(74.4%)に施行した.BAE により小腸疾患の診断・治療が大きく進歩した.しかしながら,一方で手技が煩雑な点,患者の身体的侵襲も少なくなく合併症を有する点が欠点として挙げられる.そのため,各種小腸疾患の診断,治療に対しては,個々の患者の状況により,BAEとカプセル内視鏡(capsule endoscopy; CA)とを使い分けていくことが重要である.Balloon assisted endoscopy (BAE) is a novel endoscopic technique developed to investigate small bowel diseases (SBDs). BAE has been installed from 2004 in Kawasaki Medical School Hospital. Since then, 234 patients (107 female, 117 male; mean age 62.6 years) with suspected or known SBDs underwent BAE, and we have performed a total of 325 consecutive BAE procedures. The most common indication for BAE was an obscure gastrointestinal bleeding. Cardiovascular disease was the most major coexisting disease (47 patients, 20.1%), and 53 patients (22.6%) were prescribed anti-platelet and/or anticoagulant therapy. One hundred and fifty eight patients were treated BAE via the oral approach, 167 patients were performed via the anal approach, and 56 patients were treated via the dual approach. The overall diagnostic yield was 24.0% (78/325 cases). Among the 78 cases, there were 23 erosions/ulcerations, 22 tumors, 21 angiovascular lesions, and other SBDs. The subsequent treatments, such as endoscopic therapy and surgical therapy were performed following the BAE procedure in 74.4% (58/78) of cases. BAE is a useful tool that not only allows diagnostic workup of SBDs, but also makes it possible to carry out therapeutic intervention. On the other hand, we should make careful decisions of indications for BAE, because it\u27s an invasive and complex procedure and the examination requires substantial time to complete