Ihara Eikichi, Muta Kazumasa, Fukaura Keita, Nakamura Kazuhiko
Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Digestion. 2017;95(1):29-35. doi: 10.1159/000452354. Epub 2017 Jan 5.
Based on Chicago Classification version 3.0, the disorders of esophagogastric junction outflow obstruction (EGJOO) include achalasia (types I, II and III) and EGJOO. Although no curative treatments are currently available for the treatment of the disorders of EGJOO, medical treatments, endoscopic pneumatic dilation (PD), laparoscopic Heller myotomy (LHM), and per-oral endoscopic myotomy (POEM) are usually the sought-after modes of treatment. Since the etiology and pathogenesis might vary depending on the types of EGJOO disorders, treatment strategies should be considered based on those subtypes.
Based on the accumulated evidences, the treatment strategies of our institution are as follows: effects of medical treatments on achalasia are limited. Either PD or LHM/POEM can be considered a first-line in achalasia type I, according to the patient's wish. PD and POEM can be considered first-line in achalasia types II and III, respectively. Conversely, In EGJOO, medical treatments including drugs like acotiamide and/or diltiazem can be tested as a first-line, and PD and POEM will be considered second and third-line treatments, respectively. Key Messages: The classification of subtypes based on high-resolution manometry will help us consider which treatment option can be selected as a first-line treatment depending upon the subtypes of disorders of EGJOO. Acotiamide has the potential to cure patients with EGJOO.
根据芝加哥分类第3.0版，食管胃交界部流出道梗阻（EGJOO）疾病包括贲门失弛缓症（I型、II型和III型）和EGJOO。尽管目前尚无治愈EGJOO疾病的疗法，但药物治疗、内镜下气囊扩张术（PD）、腹腔镜下Heller肌切开术（LHM）和经口内镜下肌切开术（POEM）通常是常用的治疗方式。由于EGJOO疾病的病因和发病机制可能因类型而异，因此应根据这些亚型考虑治疗策略。
根据积累的证据，我们机构的治疗策略如下：药物治疗对贲门失弛缓症的效果有限。对于I型贲门失弛缓症，可根据患者意愿，将PD或LHM/POEM视为一线治疗方法。对于II型和III型贲门失弛缓症，PD和POEM可分别视为一线治疗方法。相反，在EGJOO中，包括阿考替胺和/或地尔硫䓬等药物的药物治疗可作为一线治疗进行试验，而PD和POEM将分别视为二线和三线治疗方法。关键信息：基于高分辨率测压的亚型分类将有助于我们根据EGJOO疾病的亚型考虑选择哪种治疗方案作为一线治疗。阿考替胺有可能治愈EGJOO患者。
