Patel Dhyanesh A, Lappas Brian M, Vaezi Michael F
Dr Patel is a gastroenterology fellow in the Division of Gastroenterology, Hepatology and Nutrition; Dr Lappas is an internal medicine resident in the Department of Internal Medicine; and Dr Vaezi is a professor of medicine in the Division of Gastroenterology, Hepatology and Nutrition at Vanderbilt University Medical Center in Nashville, Tennessee.
Gastroenterol Hepatol (N Y). 2017 Jul;13(7):411-421.
Achalasia is one of the most studied esophageal motility disorders. However, the pathophysiology and reasons that patients develop achalasia are still unclear. Patients often present with dysphagia to solids and liquids, regurgitation, and varying degrees of weight loss. There is significant latency prior to diagnosis, which can have nutritional implications. The diagnosis is suspected based on clinical history and confirmed by esophageal high-resolution manometry testing. Esophagogastroduodenoscopy is necessary to rule out potential malignancy that can mimic achalasia. Recent data presented in abstract form suggest that patients with type II achalasia may be most likely, and patients with type III achalasia may be least likely, to report weight loss compared to patients with type I achalasia. Although achalasia cannot be permanently cured, palliation of symptoms is possible in over 90% of patients with the treatment modalities currently available (pneumatic dilation, Heller myotomy, or peroral endoscopic myotomy). This article reviews the clinical presentation, diagnosis, and management options in patients with achalasia, as well as potential insights into histopathologic differences and nutritional implications of the subtypes of achalasia.
贲门失弛缓症是研究最多的食管动力障碍之一。然而，贲门失弛缓症患者的病理生理学及发病原因仍不明确。患者常出现固体和液体吞咽困难、反流以及不同程度的体重减轻。诊断前存在显著的延迟，这可能会对营养状况产生影响。根据临床病史怀疑诊断，并通过食管高分辨率测压检查得以确诊。必须进行食管胃十二指肠镜检查以排除可能模拟贲门失弛缓症的潜在恶性肿瘤。以摘要形式呈现的最新数据表明，与I型贲门失弛缓症患者相比，II型贲门失弛缓症患者最有可能报告体重减轻，而III型贲门失弛缓症患者则最不可能报告体重减轻。虽然贲门失弛缓症无法永久治愈，但使用目前可用的治疗方法（气囊扩张、赫勒肌切开术或经口内镜肌切开术），超过90%的患者症状可得到缓解。本文综述了贲门失弛缓症患者的临床表现、诊断和治疗选择，以及对贲门失弛缓症各亚型组织病理学差异和营养影响的潜在见解。
