Vaezi M F, Baker M E, Achkar E, Richter J E
Center for Swallowing and Esophageal Disorders, Department of Gastroenterology, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Gut. 2002 Jun;50(6):765-70. doi: 10.1136/gut.50.6.765.
Symptom relief post pneumatic dilation is traditionally used to assess treatment success in achalasia patients. Recently, we showed that symptom relief and objective oesophageal emptying are concordant in about 70% of patients, while up to 30% of achalasia patients report near complete symptom relief despite poor oesophageal emptying of barium.
We now report the results of long term clinical follow up in these two groups of achalasia patients, assessing differences in symptomatic remission rates.
Achalasia patients undergoing pneumatic dilation since 1995 were evaluated both symptomatically and objectively at regular intervals. Pre and post dilation symptoms were recorded. Barium column height was measured five minutes after ingesting a fixed volume of barium per patient to assess oesophageal emptying. Patients who initially reported near complete symptom relief were divided into two groups based on objective findings on barium study: (1) complete oesophageal emptying (concordant group), and (2) poor oesophageal emptying (discordant group). Patients were followed prospectively for symptom recurrence.
Thirty four patients with complete symptom relief post pneumatic dilation were identified. In 22/34 (65%) patients, the degree of symptom and barium height improvements was similar (concordant group). In 10/34 (30%) patients, there was < 50% improvement in barium height (discordant group). Significantly (p<0.001) more discordant (9/10; 90%) than concordant (2/22; 9%) patients failed therapy at the one year follow up. Seventeen of 22 (77%) concordant patients were still in remission while all discordant patients had failed therapy by six years of follow up. Length of time in symptom remission (mean (SEM)) post pneumatic dilation was significantly (p=0.001) less for the discordant group (18.0 (3.6) months) compared with the concordant group (59.0 (4.8) months).
(1) Poor oesophageal emptying is present in nearly 30% of achalasia patients reporting complete symptom relief post pneumatic dilation. (2) The majority (90%) of these patients will fail within one year of treatment. (3) Timed barium oesophagram is an important tool in the objective evaluation of achalasia patients post pneumatic dilation.
气囊扩张术后症状缓解传统上用于评估贲门失弛缓症患者的治疗效果。最近，我们发现约70%的患者症状缓解与食管排空客观指标一致，而高达30%的贲门失弛缓症患者尽管钡剂食管排空不佳，但报告症状几乎完全缓解。
我们现在报告这两组贲门失弛缓症患者的长期临床随访结果，评估症状缓解率的差异。
对1995年以来接受气囊扩张术的贲门失弛缓症患者定期进行症状和客观评估。记录扩张前后的症状。每位患者摄入固定体积的钡剂五分钟后测量钡柱高度，以评估食管排空情况。最初报告症状几乎完全缓解的患者根据钡剂检查的客观结果分为两组：（1）食管完全排空（一致组），（2）食管排空不佳（不一致组）。对患者进行前瞻性随访以观察症状复发情况。
确定了34例气囊扩张术后症状完全缓解的患者。22/34（65%）例患者症状和钡剂高度改善程度相似（一致组）。10/34（30%）例患者钡剂高度改善<50%（不一致组）。在一年随访时，不一致组患者（9/10；90%）治疗失败的比例显著高于一致组患者（2/22；9%）（p<0.001）。22例一致组患者中有17例（77%）仍处于缓解状态，而所有不一致组患者在六年随访时治疗均失败。与一致组（59.0（4.8）个月）相比，不一致组气囊扩张术后症状缓解的时间（平均（标准误））显著缩短（18.0（3.6）个月）（p=0.001）。
（1）近30%报告气囊扩张术后症状完全缓解的贲门失弛缓症患者存在食管排空不佳。（2）这些患者中的大多数（90%）将在治疗一年内失败。（3）定时钡剂食管造影是气囊扩张术后贲门失弛缓症患者客观评估的重要工具。
