Goldenberg S P, Burrell M, Fette G G, Vos C, Traube M
Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut.
Gastroenterology. 1991 Sep;101(3):743-8. doi: 10.1016/0016-5085(91)90534-r.
Compared with classic achalasia, vigorous achalasia has been defined as achalasia with relatively high esophageal contraction amplitudes, often with minimal esophageal dilation and prominent tertiary contractions on radiographs, and with the presence of chest pain. However, no study using current manometric techniques has compared manometric, radiographic, and clinical findings in vigorous and classic achalasia or questioned the usefulness of making this distinction. Fifty-four cases involving patients with achalasia whose radiographic and manometric studies were performed within 6 months of each other were available for review. Patients with vigorous achalasia (n = 17), defined by amplitude greater than or equal to 37 mm Hg, and patients with classic achalasia (n = 37), defined as amplitude less than 37 mm Hg, had substantial overlap in radiographic parameters of esophageal dilation, tortuosity, and tertiary contractions. Manometric properties of repetitive waves and lower esophageal sphincter pressure and clinical aspects of chest pain, dysphagia, heartburn, and satisfactory responses to pneumatic dilation were similar in both forms of achalasia. A separate analysis of patients with mean contraction amplitude greater than 60 mm Hg revealed similar findings. It is concluded that use of amplitude as a criterion for classifying achalasia is arbitrary and of dubious value.
与经典型贲门失弛缓症相比，强力型贲门失弛缓症被定义为食管收缩幅度相对较高的贲门失弛缓症，在X线片上通常食管扩张程度最小且有明显的第三蠕动波，并且伴有胸痛。然而，尚无研究采用当前的测压技术对强力型和经典型贲门失弛缓症的测压、影像学及临床发现进行比较，也没有人质疑做出这种区分的实用性。有54例贲门失弛缓症患者可供回顾，这些患者的X线和测压研究在彼此6个月内完成。强力型贲门失弛缓症患者（n = 17），定义为幅度大于或等于37 mmHg，经典型贲门失弛缓症患者（n = 37），定义为幅度小于37 mmHg，在食管扩张、迂曲及第三蠕动波的影像学参数方面有大量重叠。两种类型的贲门失弛缓症在重复波的测压特性、食管下括约肌压力以及胸痛、吞咽困难、烧心的临床症状和对气囊扩张的满意反应方面均相似。对平均收缩幅度大于60 mmHg的患者进行单独分析也得出了类似的结果。结论是，将幅度作为贲门失弛缓症分类的标准是随意的，且价值存疑。
