Digestive Disease Research Center, Faculty of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran.
Eur J Gastroenterol Hepatol. 2011 Nov;23(12):1111-5. doi: 10.1097/MEG.0b013e328349647e.
Idiopathic achalasia (IA) is a chronic disease without definite therapy. Ethanolamine oleate (EO) has multiple biological effects, including inflammatory activities. We investigated the efficacy of EO injection in selected patients with IA.
One hundred and thirty-six patients with IA were evaluated prospectively. We evaluated the efficacy of EO injection in 13 patients with IA that are resistant to or a poor candidate of pneumatic balloon dilation and/or cardiomyotomy at the Digestive Disease Research Center, Shariati Hospital, Tehran, as the major referral center for achalasia in Iran in an interventional study. Diluted EO was injected in a divided dose into each of four quadrants of lower esophageal sphincter, using a standard sclerotherapy needle. Injection was repeated at 2 and 4 weeks after first injection. The patients were evaluated with achalasia symptom score (ASS) and timed barium esophagogram (TBE) before and after injections. Good response was defined as a decrease in ASS of at least 50% of baseline and decrease in height and volume of barium of at least 50% of baseline in TBE, at 1.5 months after the last injection. Side-effects were recorded.
All patients (13 cases) had good ASS (decreased, ≥ 50%) and good TBE (decreased in height and volume of barium, ≥ 50%) response rate. The mean ASS decreased from 11.38 (± 1.5) to 3.23 (± 1.96) at 1.5 months after the last injection (P=0.001). The mean volume of barium in TBE decreased from 81.38 ml (± 51.11) to 40.69 ml (± 61.22) at 1.5 months after the last injection (P=0.016). The mean duration of follow-up was 17.83 (± 1.12) months. Symptoms of six patients relapsed; all of them were treated effectively with reinjection.
This study indicates that EO is well tolerated and potentially effective in patients with IA that might be explained by the local inflammatory properties of EO. As presented data are too preliminary to support the routine use of EO in the treatment of all patients with IA; its use in selected cases can be considered.
特发性贲门失弛缓症（IA）是一种无明确治疗方法的慢性疾病。油酸乙醇胺（EO）具有多种生物学作用，包括炎症活性。我们研究了 EO 注射在选择的 IA 患者中的疗效。
136 例 IA 患者前瞻性评估。在德黑兰 Shariati 医院消化疾病研究中心，我们作为伊朗贲门失弛缓症的主要转诊中心，对 13 例对气动球囊扩张和/或肌切开术不耐受或效果不佳的 IA 患者进行了 EO 注射的疗效进行了干预研究。用标准硬化治疗针将稀释的 EO 分剂量注入食管下括约肌的四个象限。首次注射后 2 周和 4 周重复注射。在注射前后，患者使用贲门失弛缓症症状评分（ASS）和时间分辨钡食管造影（TBE）进行评估。良好反应定义为 ASS 至少降低 50%（基线），TBE 钡的高度和体积至少降低 50%（基线），末次注射后 1.5 个月。记录副作用。
所有患者（13 例）均有良好的 ASS（降低，≥50%）和良好的 TBE（钡高度和体积降低，≥50%）反应率。末次注射后 1.5 个月，ASS 从 11.38（±1.5）降至 3.23（±1.96）（P=0.001）。TBE 中的钡体积从 81.38ml（±51.11）降至 40.69ml（±61.22）（P=0.016）。平均随访时间为 17.83（±1.12）个月。6 例患者的症状复发；所有患者均通过再次注射有效治疗。
本研究表明，EO 耐受性良好，对可能因 EO 的局部炎症特性而导致的 IA 患者有效。由于所呈现的数据还太初步，不能支持 EO 常规用于治疗所有 IA 患者；可以考虑在选择的病例中使用。
