Dimitriu Anca, Gheorghe Cristian
Chirurgia (Bucur). 2018 Jan-Feb;113(1):61-69. doi: 10.21614/chirurgia.113.1.61.
High resolution manometry (HRM) is currently the gold standard for the diagnosis of achalasia and other functional esophageal disorders. All patients accusing dysphagia should be endoscopically evaluated prior to manometric investigations in order to rule out pseudoachalasia. The Chicago HRM classification has led to a subclassification of three manometric types of achalasia that seem to have different results to treatment. None of the actual achalasia treatment options are curative. Type II achalasia patients respond best to all treatment options compared to those with types I and III. Pneumatic dilation (PD) or Heller miotomy (LHM) can be both chosen as initial therapy in type I and II as they have good outcome , while type III achalasia patients respond better to LHM as a first therapeutic option. Peroral endoscopic myotomy (POEM) is a promising new technique but long-term follow-up studies for its safety and efficacy must be performed. This article reviews the current therapeutic options in achalasia and other functional esophageal disorders, based on the differences in safety and efficacy between approaches, highlighting the impact of HRM to predict the outcome but also the role of the techinque in guiding antireflux surgery.
高分辨率测压法（HRM）目前是诊断贲门失弛缓症和其他功能性食管疾病的金标准。所有主诉吞咽困难的患者在进行测压检查之前都应接受内镜评估，以排除假性贲门失弛缓症。芝加哥HRM分类法对贲门失弛缓症的三种测压类型进行了细分，这三种类型似乎对治疗有不同的反应。目前没有一种贲门失弛缓症的治疗方法是根治性的。与I型和III型患者相比，II型贲门失弛缓症患者对所有治疗方法的反应最佳。I型和II型贲门失弛缓症患者可选择气囊扩张术（PD）或赫勒肌切开术（LHM）作为初始治疗方法，因为它们疗效良好，而III型贲门失弛缓症患者对LHM作为首选治疗方法反应更好。经口内镜下肌切开术（POEM）是一种有前景的新技术，但必须对其安全性和疗效进行长期随访研究。本文基于不同治疗方法在安全性和疗效上的差异，综述了贲门失弛缓症和其他功能性食管疾病目前的治疗选择，强调了HRM对预测治疗结果的影响以及该技术在指导抗反流手术中的作用。
