Division of Gastroenterology and Hepatology, Kantonsspital St. Gallen, St. Gallen, Switzerland.
Division of Gastroenterology, Bern University Hospital, Berne, Switzerland.
United European Gastroenterol J. 2016 Feb;4(1):55-61. doi: 10.1177/2050640615584732. Epub 2015 May 5.
Early relapse after treatment of achalasia occurs in 10-32 % of patients. The best method to follow up these patients is not known. Symptoms often do not correlate with esophageal clearance: some patients are oligosymptomatic despite persistent esophageal stasis/dilatation.
The aim was to compare two methods of measurement of esophageal clearance (impedance manometry with barium swallow) in achalasia patients following treatment. Symptom assessment (Eckardt score/detailed dysphagia questions) was correlated with objective measurements of esophageal stasis (barium swallow and impedance manometry) in achalasia patients following treatment.
Post-treatment patients were followed up after median 38.4 months (median range 1-144 months). Symptoms were quantified using the Eckardt score and detailed dysphagia questions. Timed barium swallow quantified distal esophageal retention 0.5, 1, 3, and 5 minutes after oral contrast and impedance manometry assessed total and segmental esophageal clearance during water/viscous swallows and free drinking (200 mL).
Thirty-two patients (7 women, age 48.3; range 20-74) completed all investigations. Bolus retention in the distal esophagus assessed by impedance correlated well with barium swallow. There were no differences in impedance and timed barium swallow parameters between patients with Eckardt score 0-2 points or ≥3 points. Nine (28%) patients had an Eckardt score ≥3 points and 21 (66%) had ≥1 point in the detailed dysphagia questions. Patients without any dysphagia history had lower barium column height and width at 3 and 5 minutes compared to those with ≥1 positive answer in the detailed dysphagia questions. Correlation between the Eckardt score and detailed dysphagia questions was moderately good (r = 0.546; p = 0.001).
A detailed history of esophageal dysphagia rather than the Eckardt score is more sensitive to detect oligosymptomatic patients with disturbed esophageal clearance. Impedance manometry correlates well with the timed-barium swallow examination and represents an alternative objective assessment as it avoids radiation exposure.
在接受治疗后，贲门失弛缓症患者中有 10-32%会在早期复发。目前尚不清楚跟踪这些患者的最佳方法。症状通常与食管清除率不相关：尽管食管仍存在停滞/扩张，但有些患者的症状却很少。
本研究旨在比较两种食管清除率的测量方法（阻抗测压法结合钡餐吞咽）在贲门失弛缓症患者治疗后的应用。在治疗后，通过症状评估（Eckardt 评分/详细吞咽困难问卷）与客观食管停滞测量（钡餐吞咽和阻抗测压法）之间的相关性来评估贲门失弛缓症患者的症状。
在中位时间 38.4 个月（1-144 个月）后对治疗后的患者进行随访。使用 Eckardt 评分和详细吞咽困难问卷来量化症状。通过时间分辨钡餐来评估口服造影剂后 0.5、1、3 和 5 分钟时远端食管的滞留情况，阻抗测压法评估水/粘性吞咽和自由饮水（200ml）时的总食管清除率和节段性食管清除率。
32 名患者（7 名女性，年龄 48.3 岁；范围 20-74 岁）完成了所有检查。阻抗法评估的食管下段食团滞留与钡餐检查相关性良好。Eckardt 评分 0-2 分和≥3 分的患者之间，阻抗和时间分辨钡餐参数无差异。9 名（28%）患者的 Eckardt 评分≥3 分，21 名（66%）患者的详细吞咽困难问卷有≥1 项阳性。没有吞咽困难病史的患者在 3 分钟和 5 分钟时的钡柱高度和宽度低于在详细吞咽困难问卷中有≥1 个阳性答案的患者。Eckardt 评分与详细吞咽困难问卷之间的相关性为中度良好（r=0.546;p=0.001）。
详细的食管吞咽困难史比 Eckardt 评分更能敏感地检测出食管清除率异常的少症状患者。阻抗测压法与时间分辨钡餐检查相关性良好，作为一种替代的客观评估方法，它避免了辐射暴露。
