Niebisch S, Hadzijusufovic E, Mehdorn M, Müller M, Scheuermann U, Lyros O, Schulz H G, Jansen-Winkeln B, Lang H, Gockel I
Department of Visceral, Transplant, Thoracic and Vascular Surgery, University of Leipzig Medical Center, Leipzig, Germany.
Department of General, Visceral and Transplant Surgery, University of Mainz Medical Center, Mainz, Germany.
Dis Esophagus. 2017 May 1;30(5):1-6. doi: 10.1093/dote/dow004.
Although achalasia presents with typical symptoms such as dysphagia, regurgitation, weight loss, and atypical chest pain, the time until first diagnosis often takes years and is frustrating for patients and nevertheless associated with high costs for the healthcare system. A total of 563 patients were interviewed with confirmed diagnosis of achalasia regarding their symptoms leading to diagnosis along with past clinical examinations and treatments. Included were patients who had undergone their medical investigations in Germany. Overall, 527 study subjects were included (male 46%, female 54%, mean age at time of interview 51 ± 14.8 years). Dysphagia was present in 86.7%, regurgitation in 82.9%, atypical chest pain in 79%, and weight loss in 58% of patients before diagnosis. On average, it took 25 months (Interquartile Range (IQR) 9-65) until confirmation of correct diagnosis of achalasia. Though, diagnosis was confirmed significantly quicker (35 months IQR 9-89 vs. 20 months IQR 8-53; p < 0.01) in the past 15 years. The majority (72.1%) was transferred to three or more specialists. Almost each patient underwent at least one esophagogastroduodenoscopy (94.2%) and one radiological assessment (89.3%). However, esophageal manometry was performed in 70.4% of patients only. The severity of symptoms was independent with regard to duration until first diagnosis (Eckardt score 7.14 ± 2.64 within 12 months vs. 7.29 ± 2.61 longer than 12 months; P = 0.544). Fifty-five percent of the patients primarily underwent endoscopic dilatation and 37% a surgical myotomy. Endoscopic dilatation was realized significantly faster compared to esophageal myotomy (1 month IQR 0-4 vs. 3 months IQR 1-11; p < 0.001). Although diagnosis of achalasia was significantly faster in the past 15 years, it still takes almost 2 years until the correct diagnosis of achalasia is confirmed. Alarming is the fact that although esophageal manometry is known as the gold standard to differentiate primary motility disorders, only three out of four patients had undergone this diagnostic pathway during their diagnostic work-up. Better education of medical professionals and broader utilization of highly sensitive diagnostic tools, such as high-resolution manometry, are strictly necessary in order to correctly diagnose affected patients and to offer therapy faster.
尽管贲门失弛缓症表现出典型症状，如吞咽困难、反流、体重减轻和非典型胸痛，但首次诊断往往需要数年时间，这让患者感到沮丧，而且对医疗系统来说成本也很高。共有563名确诊为贲门失弛缓症的患者接受了关于导致诊断的症状以及过去临床检查和治疗的访谈。其中包括在德国接受医学检查的患者。总体而言，纳入了527名研究对象（男性46%，女性54%，访谈时平均年龄51±14.8岁）。诊断前，86.7%的患者有吞咽困难，82.9%有反流，79%有非典型胸痛，58%有体重减轻。平均而言，确诊贲门失弛缓症的正确诊断需要25个月（四分位间距（IQR）9 - 65）。不过，在过去15年中，诊断确认明显更快（35个月IQR 9 - 89对比20个月IQR 8 - 53；p < 0.01）。大多数患者（72.1%）转诊至三名或更多专科医生处。几乎每位患者都至少接受了一次食管胃十二指肠镜检查（94.2%）和一次放射学评估（89.3%）。然而，仅70.4%的患者进行了食管测压。症状严重程度与首次诊断前的持续时间无关（12个月内Eckardt评分为7.14±2.64，超过12个月为7.29±2.61；P = 0.544）。55%的患者主要接受了内镜扩张，37%接受了手术肌切开术。与食管肌切开术相比，内镜扩张实现得明显更快（1个月IQR 0 - 4对比3个月IQR 1 - 11；p < 0.001）。尽管在过去15年中贲门失弛缓症的诊断明显更快，但确诊贲门失弛缓症的正确诊断仍需近2年时间。令人担忧的是，尽管食管测压被认为是区分原发性动力障碍的金标准，但在诊断检查过程中，四分之三的患者中只有三分之一接受了这种诊断途径。为了正确诊断受影响的患者并更快地提供治疗，严格有必要加强对医学专业人员的教育并更广泛地使用高灵敏度诊断工具，如高分辨率测压。
