Department of Medicine, Motility and Functional Gut Disorders Unit, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), University Hospital Germans Trias i Pujol, Autonomous University of Barcelona, Badalona, Spain.
Gastroenterology Department, Hospital de Sant Pau, Autonomous University of Barcelona, Barcelona, Spain.
Neurogastroenterol Motil. 2018 Oct;30(10):e13438. doi: 10.1111/nmo.13438. Epub 2018 Aug 13.
Patients with achalasia develop a well-defined obstructive pattern of pressure in response to a rapid drink challenge test (RDC). Our aim was to determine if successful treatment of achalasia can revert the obstructive pattern of pressure in response to the RDC, and if this simple test could be useful in the follow-up of patients with achalasia.
In 26 healthy controls and 103 patients with achalasia, pressure responses to a RDC were prospectively analysed using high resolution esophageal manometry in two consecutive protocols: (a) Development study: one RDC was performed in 20 healthy controls, 63 patients with nontreated achalasia, and 21 patients with previously treated achalasia; (b) Validation study: two RDC were performed before, and 8-12 weeks after treatment, in 19 patients with nontreated, newly diagnosed achalasia.
In the development study no healthy control, 19% of patients with previously treated achalasia and 96% of patients with nontreated achalasia developed an obstructive pressure pattern during the RDC (P < 0.001). In the validation study, 100% of patients had an obstructive pressure pattern before treatment, that reverted to a nonobstructive pattern in 89% of patients after treatment (P < 0.001). The obstructive pressure pattern during the RDC correlated with clinical symptoms (Eckardt score > 3; P < 0.001), and with the height of the water column retained after the RDC, as assessed by impedance (P = 0.015).
CONCLUSIONS & INFERENCES: The RDC may objectively assess treatment outcome in patients with achalasia, and can be recommended in the evaluation of achalasia.
贲门失弛缓症患者对快速饮液挑战试验（RDC）会产生明确的梗阻性压力模式。我们的目的是确定贲门失弛缓症的成功治疗是否可以使 RDC 反应的压力恢复为梗阻模式，以及该简单测试是否可用于贲门失弛缓症患者的随访。
在 26 名健康对照者和 103 名贲门失弛缓症患者中，使用高分辨率食管测压法前瞻性地分析了对 RDC 的压力反应，共进行了两个连续的方案：（a）开发研究：20 名健康对照者、63 名未经治疗的贲门失弛缓症患者和 21 名经治疗的贲门失弛缓症患者进行了一次 RDC；（b）验证研究：19 名新诊断未经治疗的贲门失弛缓症患者在治疗前和治疗后 8-12 周进行了两次 RDC。
在开发研究中，无健康对照者、19%的经治疗的贲门失弛缓症患者和 96%的未经治疗的贲门失弛缓症患者在 RDC 期间出现了梗阻性压力模式（P<0.001）。在验证研究中，100%的患者在治疗前存在梗阻性压力模式，在治疗后 89%的患者中恢复为非梗阻性模式（P<0.001）。RDC 期间的梗阻性压力模式与临床症状（Eckardt 评分>3；P<0.001）相关，并且与 RDC 后阻抗测量的水柱保留高度相关（P=0.015）。
RDC 可客观评估贲门失弛缓症患者的治疗效果，可推荐用于评估贲门失弛缓症。
