Ponds F A, Bredenoord A J, Kessing B F, Smout A J P M
Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Neurogastroenterol Motil. 2017 Jan;29(1). doi: 10.1111/nmo.12908. Epub 2016 Jul 25.
Manometric criteria to diagnose achalasia are absent peristalsis and incomplete relaxation of the esophagogastric junction (EGJ), determined by an integrated relaxation pressure (IRP) >15 mm Hg. However, EGJ relaxation seems normal in a subgroup of patients with typical symptoms of achalasia, no endoscopic abnormalities, stasis on timed barium esophagogram (TBE), and absent peristalsis on high-resolution manometry (HRM). The aim of our study was to further characterize these patients by measuring EGJ distensibility and assessing the effect of achalasia treatment.
Impedance planimetry (EndoFLIP) was used to measure EGJ distensibility and compared to previous established data of 15 healthy subjects. In case the EGJ distensibility was impaired, achalasia treatment followed. Eckardt score, HRM, TBE, and EGJ distensibility measurements were repeated >3 months after treatment.
We included 13 patients (5 male; age 19-59 years) with typical symptoms of achalasia, Eckardt score of 7 (5-7). High-resolution manometry showed absent peristalsis with low basal EGJ pressure of 10 (5.8-12.9) mm Hg and IRP of 9.3 (6.1-12) mm Hg. Esophageal stasis was 4.6 (2.7-6.9) cm after 5 minutes. Esophagogastric junction distensibility was significantly reduced in patients compared to healthy subjects (0.8 [0.7-1.2] mm /mm Hg vs 6.3 [3.8-8.7] mm /mm Hg). Treatment significantly improved the Eckardt score (7 [5-7] to 2 [1-3.5]) and EGJ distensibility (0.8 [0.7-1.2] mm /mm Hg to 3.5 [1.5-6.1] mm /mm Hg).
CONCLUSIONS & INFERENCES: A subgroup of patients with clinical and radiological features of achalasia but manometrically normal EGJ relaxation has an impaired EGJ distensibility and responds favorably to achalasia treatment. Our data suggest that this condition can be considered as achalasia and treated as such.
诊断贲门失弛缓症的测压标准是蠕动消失以及食管胃交界部（EGJ）松弛不完全，通过综合松弛压（IRP）>15 mmHg来确定。然而，在一部分有典型贲门失弛缓症症状、内镜检查无异常、定时食管钡餐造影（TBE）显示有淤滞且高分辨率测压（HRM）显示蠕动消失的患者中，EGJ松弛似乎正常。我们研究的目的是通过测量EGJ扩张性并评估贲门失弛缓症治疗效果来进一步描述这些患者的特征。
使用阻抗平面测量法（EndoFLIP）测量EGJ扩张性，并与15名健康受试者先前建立的数据进行比较。如果EGJ扩张性受损，则进行贲门失弛缓症治疗。治疗后3个月以上重复进行埃卡德特评分、HRM、TBE和EGJ扩张性测量。
我们纳入了13例患者（5例男性；年龄19 - 59岁），具有典型的贲门失弛缓症症状，埃卡德特评分为7（5 - 7）。高分辨率测压显示蠕动消失，基础EGJ压力低，为10（5.8 - 12.9）mmHg，IRP为9.3（6.1 - 12）mmHg。5分钟后食管淤滞为4.6（2.7 - 6.9）cm。与健康受试者相比，患者的食管胃交界部扩张性显著降低（0.8 [0.7 - 1.2] mm /mmHg对6.3 [3.8 - 8.7] mm /mmHg）。治疗显著改善了埃卡德特评分（从7 [5 - 7]降至2 [1 - 3.5]）和EGJ扩张性（从0.8 [0.7 - 1.2] mm /mmHg升至3.5 [1.5 - 6.1] mm /mmHg）。
一组具有贲门失弛缓症临床和放射学特征但测压显示EGJ松弛正常的患者存在EGJ扩张性受损，并且对贲门失弛缓症治疗反应良好。我们的数据表明，这种情况可被视为贲门失弛缓症并进行相应治疗。
