Sanagapalli Santosh, Sweis Rami
GI Physiology Unit, Elizabeth Garrett Anderson Wing, University College Hospital, 235 Euston Rd, London, NW1 2BU, UK.
St. Vincent's Hospital Sydney, Department Gastroenterology, 235 Euston Rd, 390 Victoria St, NSW, 2010, Australia.
Curr Gastroenterol Rep. 2017 Jun;19(6):27. doi: 10.1007/s11894-017-0568-7.
This review aims to shed light on subtleties of achalasia diagnosis, including potential pitfalls that may lead to errors. Optimal methods for assessment of disease severity and the relationship between achalasia and other motility disorders will also be reviewed with an emphasis on recent findings from the literature.
Adjunctive testing with viscous substances or larger water volumes should be used routinely as it improves the accuracy of achalasia diagnosis. Chronic opiate use can mimic achalasia. The timed barium swallow remains the best test for assessments of disease severity and prognostication, but the functional lumen-imaging probe, a newer tool which measures esophagogastric junction distensibility using impedance planimetry, is emerging as a potentially more powerful tool for these purposes. Functional esophagogastric junction outflow obstruction is possibly part of the achalasia spectrum. By addressing the potential pitfalls described, and through routine and standardized use of the diagnostic tools mentioned herein, the accuracy of diagnosis, severity assessment, and prognostication of achalasia can be improved.
本综述旨在阐明贲门失弛缓症诊断的细微之处，包括可能导致错误的潜在陷阱。还将综述评估疾病严重程度的最佳方法以及贲门失弛缓症与其他动力障碍之间的关系，并重点介绍文献中的最新发现。
应常规使用粘性物质或大量水进行辅助检测，因为这可提高贲门失弛缓症诊断的准确性。长期使用阿片类药物可模拟贲门失弛缓症。定时吞钡检查仍然是评估疾病严重程度和预后的最佳检查，但功能性管腔成像探头作为一种使用阻抗平面测量法测量食管胃交界处扩张性的新工具，正逐渐成为用于这些目的的一种潜在更强大的工具。功能性食管胃交界处流出道梗阻可能是贲门失弛缓症谱系的一部分。通过解决所述潜在陷阱，并通过常规和标准化使用本文提及的诊断工具，可提高贲门失弛缓症诊断、严重程度评估和预后的准确性。
