Department of Gastroenterology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China.
J Dig Dis. 2020 Sep;21(9):490-497. doi: 10.1111/1751-2980.12922. Epub 2020 Aug 26.
We aimed to identify the differences in symptoms, high-resolution manometry (HRM) characteristics, and the efficacy of peroral endoscopic myotomy (POEM) regarding patients' sex in achalasia.
All patients diagnosed with achalasia by HRM who underwent POEM and were followed up for more than 6 months were included. The individual characteristics, symptoms and signs, POEM findings, HRM results and potentially related complications in male and female patients were reviewed.
Prior to POEM, dysphagia was more severe in female than male patients (P = 0.044), while regurgitation was more severe (P = 0.013) and heartburn was more common in male patients (P = 0.003). Regarding HRM characteristics, the lower esophageal sphincter pressure (LESP) was higher (P = 0.01) and length of esophagus was shorter in female patients than in male patients. Eckardt scores, LESP and integrated relaxation pressure were significantly improved after the POEM procedure (P < 0.001). No significant difference was observed between the sexes regarding the efficacy of POEM, reflux symptoms, HRM data and complications after POEM.
Before they seek treatment, female patients with achalasia may experience severe dysphagia and male patients are more likely to experience heartburn and more severe regurgitation. POEM is a safe and effective option for treating both male and female patients with achalasia.
我们旨在确定贲门失弛缓症患者在症状、高分辨率测压（HRM）特征和经口内镜肌切开术（POEM）疗效方面的性别差异。
纳入所有经 HRM 诊断为贲门失弛缓症、接受 POEM 治疗且随访时间超过 6 个月的患者。回顾分析男性和女性患者的个体特征、症状和体征、POEM 发现、HRM 结果和潜在相关并发症。
在 POEM 治疗前，女性患者的吞咽困难比男性患者更严重（P = 0.044），而男性患者的反流更严重（P = 0.013）且烧心更常见（P = 0.003）。在 HRM 特征方面，女性患者的食管下括约肌压力（LESP）较高（P = 0.01）且食管长度较短。POEM 术后 Eckardt 评分、LESP 和整体松弛压力均显著改善（P < 0.001）。POEM 疗效、反流症状、HRM 数据和 POEM 后并发症方面，男女之间无显著差异。
在寻求治疗之前，女性贲门失弛缓症患者可能会经历严重的吞咽困难，而男性患者更可能出现烧心和更严重的反流。POEM 是治疗男女贲门失弛缓症患者的安全有效选择。
