Shiino Y, Houghton S G, Filipi C J, Awad Z T, Tomonaga T, Marsh R E
Department of Surgery, Creighton University School of Medicine, Omaha, NE 68131, USA.
J Am Coll Surg. 1999 Aug;189(2):158-63. doi: 10.1016/s1072-7515(99)00091-5.
Although morphologic, radiographic, and manometric features of achalasia have been well defined, it has not been established by careful retrospective analysis whether achalasia is a progressive disorder resulting in complete decompensation.
To verify the hypothesis that achalasia is a progressive disease, we retrospectively investigated manometric, radiographic, and symptomatic data in patients with achalasia. Sixty-three patients (36 women and 27 men) with a median age of 44 years (range 11 to 79 years) were evaluated. The duration of symptoms ranged from 1 to 442 months, with a median of 48 months. Patients were divided into four groups according to the duration of symptoms: 36 patients with less than 5 years, 11 with 5 to 10 years, 9 with 10 to 15 years, and 7 with 15 years or more.
Contraction pressures of the esophageal body decreased significantly at every level when the duration of symptoms increased (p < 0.04). The percentage of simultaneous waves in the esophageal body rose as the duration of symptoms increased. All waves were synchronous in every patient who had had symptoms for more than 15 years. The maximal width of the esophageal body measured on esophagram became greater with an increase in the duration of symptoms, but this measurement did not reach statistical significance (p = 0.063). The tortuosity of the esophagus, measured by the maximal angle of the esophageal axis, was significantly greater in patients with a longer duration of symptoms (p < 0.02). The type of symptoms was not associated with the duration of symptoms.
Achalasia is a progressive disease, as verified by manometric and radiographic findings. The classification of esophageal motor function expressed by amplitude of contraction pressure and angle of tortuosity is objective and useful. Classification of achalasia by duration of symptoms may be important in treatment selection and effectiveness.
尽管贲门失弛缓症的形态学、影像学和测压特征已得到明确界定，但尚未通过仔细的回顾性分析确定贲门失弛缓症是否为一种会导致完全失代偿的进行性疾病。
为验证贲门失弛缓症是一种进行性疾病这一假设，我们回顾性研究了贲门失弛缓症患者的测压、影像学和症状数据。对63例患者（36例女性和27例男性）进行了评估，中位年龄为44岁（范围11至79岁）。症状持续时间为1至442个月，中位时间为48个月。根据症状持续时间将患者分为四组：症状持续时间小于5年的患者36例，5至10年的患者11例，10至15年的患者9例，15年及以上的患者7例。
随着症状持续时间的增加，食管体部各水平的收缩压显著降低（p < 0.04）。食管体部同步波的百分比随着症状持续时间的增加而升高。所有症状持续超过15年的患者的波均为同步波。食管造影测得的食管体部最大宽度随着症状持续时间的增加而增大，但该测量未达到统计学意义（p = 0.063）。通过食管轴最大角度测量的食管迂曲度在症状持续时间较长的患者中显著更大（p < 0.02）。症状类型与症状持续时间无关。
测压和影像学结果证实贲门失弛缓症是一种进行性疾病。以收缩压幅度和迂曲角度表示的食管运动功能分类客观且有用。根据症状持续时间对贲门失弛缓症进行分类在治疗选择和疗效方面可能很重要。
