Park Jung Ho, Lee Yong Chan, Lee Hyuk, Park Hyojin, Youn Young Hoon, Park Hyung Seok, Lee Tae Hee, Hong Kyoung Sup
Department of Internal Medicine, Sungkyunkwan University College of Medicine, Seoul, Korea.
J Gastroenterol Hepatol. 2015 Jan;30(1):59-63. doi: 10.1111/jgh.12642.
Pneumatic balloon dilatation (PD) is a mainstay in achalasia treatment. The aim of this study was to identify predictive factors for successful treatment.
We retrospectively reviewed 76 patients with a diagnosis of achalasia who underwent PD from June 2010 to May 2013. Clinical symptoms were assessed using Eckardt score and manometry data were analyzed using resting and relaxation pressure (4sIRP) of lower esophageal sphincter (LES) and the distal contractile integral (DCI), which was calculated for 10 s from the start of deglutition between the upper margin of the LES and lower margin of upper esophageal contraction. Patients with achalasia were classified into three groups based on the Chicago classification.
Among 76 patients, 52 patients received PD, and the treatment was unsuccessful in 9 patients (6 in class I and 3 in class III). When comparing prognostic factors between successful and unsuccessful treatment groups, the mean value for 4sIRP in the unsuccessful treatment group was significantly lower than that in the successful treatment group (P < 0.05). However, no difference was noticed in resting LES pressure, DCI, age, and sex. Furthermore, a lower mean value of 4sIRP was significantly related to unsuccessful treatment of achalasia (odds ratio, 1.092; 95% confidence interval, 1.001-1.191) even after adjustment for a series of confounding factors.
Lower 4sIRP may be a prognostic indicator for poor treatment outcome after PD.
气囊扩张术（PD）是贲门失弛缓症治疗的主要手段。本研究旨在确定成功治疗的预测因素。
我们回顾性分析了2010年6月至2013年5月期间接受PD治疗的76例贲门失弛缓症患者。采用埃卡德特评分评估临床症状，并分析食管下括约肌（LES）的静息和松弛压力（4sIRP）以及远端收缩积分（DCI）的测压数据，DCI是从吞咽开始至LES上缘与食管上段收缩下缘之间10秒内计算得出的。根据芝加哥分类法，将贲门失弛缓症患者分为三组。
76例患者中，52例接受了PD治疗，9例治疗失败（I类6例，III类3例）。比较成功和失败治疗组的预后因素时，失败治疗组的4sIRP平均值显著低于成功治疗组（P < 0.05）。然而，LES静息压力、DCI、年龄和性别方面未发现差异。此外，即使在调整一系列混杂因素后，较低的4sIRP平均值仍与贲门失弛缓症治疗失败显著相关（优势比，1.092；95%置信区间，1.001 - 1.191）。
较低的4sIRP可能是PD治疗后预后不良的一个预后指标。
