Читать книгу The Esophagus - Группа авторов - Страница 223

In the next step of the hierarchical analysis, each swallow is classified, guided by the previous metrics [4] (Figures 8.3 and 8.4). Swallow types include:

 Premature: DL less than the lower limit of normal, typically <4.5 s with a DCI > 450 mmHg•s•cm

 Hypercontractile: DCI greater than the upper limit of normal (typically > 8000 mmHg•s•cm)

 Failed: DCI < 100 mmHg•s•cm or DCI < 450 mmHg•s•cm with a distal latency < 4.5 s; also classified as an ineffective swallowFailed swallows with panesophageal pressurization

 Weak: DCI 100–450 mmHg•s•cm; also classified as an ineffective swallow

 Fragmented: DCI > 450 mmHg•s•cm with a large (> 5 cm) peristaltic break

 Normal: Not meeting the previous criteria; hence DCI 450–8000 mmHg•s•cm without a large peristaltic break and DL ≥ 4.5 s

Figure 8.4 Swallow types of HRM/EPT. (A) Premature swallow; the distal latency (arrow) is 4 seconds. (B) Hypercontractile swallow: the distal contractile integral (DCI; white dashed box) was 28 000 mmHg•s•cm, and the distal latency was 6 seconds. (C) Failed swallow. (D) Weak swallow; DCI 400 mmHg•s•cm with only a small peristaltic break in the 20 mmHg isobaric contour. (E) Fragmented swallow; DCI 740 mmHg•s•cm with large (> 5 cm) peristaltic break. (F) Normal swallow.

Source: Used with permission from the Esophageal Center at Northwestern University.