Fisichella P Marco, Jalilvand Anahita, Lebenthal Abraham
Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA,
World J Surg. 2015 Jul;39(7):1593-7. doi: 10.1007/s00268-014-2939-7.
From the earliest description of dysphagia relieved by dilatation with a whalebone in 1674 we have witnessed the evolution of esophageal function testing from the conventional manometry to the high-resolution manometry (HRM) and esophageal topography pressure plotting that have led to the revised Chicago classification for esophageal motility disorders in 2014. The goals of this paper are, therefore, (1) to highlight the historical milestones that have led to the diagnostic definition of achalasia, as we know it today; (2) to describe the evaluation process of patients with suspected achalasia; (3) to describe the diagnostic value of the HRM and the usefulness of the Chicago classification in predicting treatment outcomes. The value of Chicago classification is linked to the ability of the clinician to perform a thorough clinical evaluation to identify and correlate specific clinical phenotypes to specific manometric subtypes and predict treatment outcomes. Chicago classification, however, cannot predict which treatment, pneumatic dilatation, or Heller myotomy, should be selected for those with a specific subtype of achalasia.
从1674年用鲸骨扩张缓解吞咽困难的最早描述开始，我们见证了食管功能测试从传统测压法发展到高分辨率测压法（HRM）以及食管地形压力绘图，这些发展促成了2014年食管动力障碍的修订版芝加哥分类。因此，本文的目的是：（1）突出导致我们如今所知的贲门失弛缓症诊断定义的历史里程碑；（2）描述疑似贲门失弛缓症患者的评估过程；（3）描述HRM的诊断价值以及芝加哥分类在预测治疗结果方面的实用性。芝加哥分类的价值与临床医生进行全面临床评估的能力相关，以便识别特定临床表型并将其与特定测压亚型相关联，进而预测治疗结果。然而，芝加哥分类无法预测对于特定亚型的贲门失弛缓症患者应选择哪种治疗方法，即气囊扩张术还是赫勒肌切开术。
