A multidisciplinary approach to identifying and managing heterotopic gastric inlet patches

医学 吞咽困难 吞咽 喉部 咽喉反流 格尔德 接收机工作特性 回流 生物电阻抗分析 内科学 外科 胃肠病学 体质指数 疾病
作者
Lucas Celestino Guerzet Ayres,S. Perring,S.A.R. Nouraei
出处
期刊:Neurogastroenterology and Motility [Wiley]
卷期号:36 (4)
标识
DOI:10.1111/nmo.14768
摘要

Abstract Introduction Gastric inlet patches are often incidental, but can also be a treatable cause of laryngo‐esophageal symptoms. Methods We retrospectively reviewed all patients whose gastric inlet patches were diagnosed following assessment for laryngopharyngeal and swallowing symptoms. Improvement following Argon Plasma Coagulation (APC) was assessed using Minimum Clinically‐Important Difference methodology combining voice, throat, and swallowing domains. Correlations between APC response and measures of reflux and mucosal barrier integrity, measured during 24‐h pH‐impedance manometry, were obtained. Proximal and Distal Mean Nocturnal Baseline Impedance (MNBI) values were separately calculated and the novel variable of Mucosal Impedance Gradient was derived as [((Distal MNBI‐Proximal MNBI)/((Distal MNBI + Proximal MMBI)/2)) x 100]. Key Results Inlet patches were detected in 57 of 651 patients who had Transnasal Panendoscopy (8.7 ± 2.2%). There were 34 males. Mean age was 58 years. Mean duration of symptoms was 2 years. The commonest symptoms were hoarseness ( n = 33), throat symptoms ( n = 24), and dysphagia ( n = 21), respectively. APC was used to ablate patches in 34 patients. Treatment response was 71% at a mean followup of 5.5 months. MIG > − 25% predicted response to APC, with area under the receiver operating characteristic curve of 0.875 (Sensitivity = 81%; Specificity = 100%; p < 0.0001). Conclusions Gastric inlet patches are common and under‐recognized. They can cause protracted pharyngo‐esophageal symptoms. Patch ablation is an effective treatment for carefully selected patients. Optimal patient selection requires multidisciplinary teamwork. Mucosal Impedance Gradient could further refine patient selection.
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