Study Of Esophageal Motility In The Cases With Myasthenia Gravis

Aims: The research was designed to study the features of esophageal motility in different clinical subtypes and pathological types myasthenia gravis(MG),to get more details of the esophageal manometric characteristics,and provid an objective basis for elucidating the diagnosis and evaluating therapies of MG.Methods: From October.2013 to April.2015,fifteen healthy controls and forty-five inpatients with MG from the third affiliated hospital of the Third Military Medical University,were tested by using a low-compliance four-lumen hydraulic infusion system respectively.We focused on the following parameters i.e.PP(pharyngeal pressure),UESP(upper esophageal sphincter pressure),UEP(upper esophageal contract pressure),MEP(middle esophageal contract pressure)and MERP(middle esophageal rest pressure).And made further analysis into the effect on esophageal motor function between the Osserman types,dysphagia or non-dysphagia,whether with thymoma of MG,and also investigated the relationship of the thymus weight and thymus index with the gender,type of Osserman,whether with dysphagia and whether with thymoma.Results:1、There were significant differences of the parameters between MG cases and healthy controls(PP: 73.24±31.40 vs.103.78±29.47 mm Hg,P=0.002;UESP:41.75±21.04 vs.60.59±17.97 mmHg,P=0.003;UEP: 56.63±30.26 vs.78.98±30.14 mm Hg,P=0.016;MEP: 53.96±23.25 vs.75.11±23.75 mm Hg(P=0.004).However,MERP of MG cases or healthy controls seemed to be similar(-7.76 ±5.94 vs.-7.58±5.76 mm Hg,P= 0.91).2、In the 45 patients,according to modified Osserman classification,there were 25 cases ocular MG(classⅠ),20 cases generalized MG(8 cases in class Ⅱa,11 cases in class Ⅱb,and 1 case in class Ⅲ).There were significant differences in the parameters of the g MG group and the healthy controls(P<0.01).Difference between groups of the PP of o MG and g MG was also significant difference(P<0.01),the other parameters between groups were statistically significant difference(P< 0.05),but the parameters between o MG group and the healthy controls were no statistically significant(P > 0.05)3、The patients were classified under dysphagia group(18 cases)and non-dysphagia group(27 cases),There was significant difference between groups(P<0.01).Comparisons between dysphagia group and healthy controls were also significant difference(P<0.01),but there was no significant difference between non-dysphagia group and healthy controls(P>0.05).4、Grouped by thymomatous and non-thymomatous MG,according to the histologic classification of thymoma by the World Health Organization in 1999,the result of postoperative pathological examination showed as follow: thymic cyst in 4 cases,8 cases of type B1 thymoma,7 cases of type B2,B3 in 1 case.thymic hyperplasia in 23 patients,thymic atrophy in 2 cases,Comparisons between thymomatous group(20 cases)and non-thymomatous group(25 cases)were no significant(P>0.05).5、The weight of thymus of 45 cases Mg was 43.52 ±18.39g(12.90~106.07g),and the thymus index was 0.07±0.02%(0.03~0.15%),comparisons of the thymus weight and thymus index in different sex or Osserman subtypes were no statistical difference(P> 0.05),but the comparisons were significant difference(P< 0.05)between groups of thmyomatous MG and non-thmyomatous MG.Conclusions: 1、The upper and middle part of esophageal motility dysfunction is very common in MG cases,characterizing by the declined of UESP and contract pressure of upper and middle esophagus.2、The effect on esophageal motor function is mainly in patients of g MG and those with dysphagia symptom,the esophageal motility function of o MG and non-dysphagia patients is basically similar with the healthy subjects.3 、 There is no significant correlation with esophageal motor function between thymomatous MG and non-thymomatous MG.4、The thymus weight and thymus index has no significant corresponding with gender,Osserman subtype and whether with dysphagia of the patients with MG,but there is significant statistically difference between thymomatous MG and non-thymomatous MG.5、Esophageal manometry provides important clinical values in diagnosis of MG,it can objectively reflects the situation of esophageal striated muscle involvements in patients with MG.In general,it could be an objective basis as reflecting the esophageal motor function of MG.