Division of Gastroenterology, University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Boulevard, 7th Floor, South Tower, Philadelphia, PA, 19104, USA.
Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, 423 Guardian Drive, 733 Blockley Hall, Philadelphia, PA, 19104, USA.
Dig Dis Sci. 2018 May;63(5):1243-1249. doi: 10.1007/s10620-018-4985-8. Epub 2018 Feb 22.
Achalasia is an esophageal motor disorder that leads to swallowing dysfunction and weight loss. Nutritional risk in achalasia patients is not well defined.
The aims of this study were to define baseline body mass index (BMI), changes in weight, and nutritional risk over time in a large cohort of achalasia patients.
This was a retrospective cohort study of achalasia patients at a tertiary care center with documented BMI, symptom severity as per Eckardt score, and nutritional risk assessment as per the Malnutrition Universal Screening Tool, which considers BMI, degree of recent weight loss, and acuity of disease.
Among the 337 patients presenting for achalasia management, 179 had confirmed disease. Upon presentation 69.8% of patients were classified as overweight or obese. Using the Malnutrition Universal Screening Tool, we found 50% of patients to be at moderate or high risk for malnutrition at presentation. Eckardt score (OR 1.15, 95% CI 1.05-1.26), duration of disease (OR for each additional month 1.04, 95% CI 1.01-1.08), and female gender (OR 1.76, 95% CI 1.02-3.03) were independent predictors of increased risk for malnutrition. Nutrition risk score decreased after therapy in 93.3% of patients.
Despite a high prevalence of overweight and obese status in achalasia patients, many are at risk of developing nutritional complications secondary to rapid weight loss. This risk frequently resolves post-treatment. Regardless of baseline BMI, we recommend all patients undergo nutritional assessment to identify high-risk patients who may benefit from dietary intervention and expedited therapy.
贲门失弛缓症是一种食管动力障碍，可导致吞咽功能障碍和体重减轻。贲门失弛缓症患者的营养风险尚未得到充分定义。
本研究旨在定义大量贲门失弛缓症患者的基线体重指数（BMI）、体重变化和随时间推移的营养风险。
这是一项对一家三级保健中心的贲门失弛缓症患者进行的回顾性队列研究，记录了 BMI、Eckardt 评分（根据该评分判断症状严重程度）和营养不良通用筛查工具（Malnutrition Universal Screening Tool，MUST）评估的营养风险，后者考虑了 BMI、近期体重减轻程度和疾病严重程度。
在 337 名就诊于贲门失弛缓症治疗中心的患者中，179 名患者确诊为贲门失弛缓症。就诊时，69.8%的患者超重或肥胖。使用 MUST，我们发现 50%的患者在就诊时存在中重度营养不良风险。Eckardt 评分（OR 1.15，95%CI 1.05-1.26）、疾病持续时间（每个额外月 OR 1.04，95%CI 1.01-1.08）和女性（OR 1.76，95%CI 1.02-3.03）是营养不良风险增加的独立预测因素。93.3%的患者在治疗后营养风险评分降低。
尽管贲门失弛缓症患者超重和肥胖的患病率较高，但许多患者因体重迅速减轻而存在发生营养并发症的风险。这种风险在治疗后通常会降低。无论基线 BMI 如何，我们建议所有患者接受营养评估，以识别高风险患者，这些患者可能受益于饮食干预和加速治疗。
