症状持续时间和测压参数为假性贲门失弛缓症的诊断提供线索。
Duration of symptoms and manometric parameters offer clues to diagnosis of pseudoachalasia.
机构信息
Division of Gastroenterology, Washington University School of Medicine, Saint Louis, MO, USA.
出版信息
Neurogastroenterol Motil. 2021 Jan;33(1):e13965. doi: 10.1111/nmo.13965. Epub 2020 Aug 10.
BACKGROUND
Pseudoachalasia manifests high-resolution manometry (HRM) findings of achalasia but results from a secondary process. We analyzed clinical and HRM characteristics of pseudoachalasia, including malignant and non-malignant subtypes.
METHODS
High-resolution manometry was retrospectively reviewed in patients with confirmed pseudoachalasia, and corroborated with endoscopic and radiographic studies. A control cohort of idiopathic achalasia patients was identified. Clinical characteristics, Eckardt score, and HRM metrics were extracted from institutional records. Grouped data and medians (interquartile range) were compared between pseudoachalasia and idiopathic achalasia, and between malignant and non-malignant pseudoachalasia, using parametric and non-parametric statistical tests.
KEY RESULTS
Of 28 pseudoachalasia patients (62.2 ± 2.5 years, 60.7% female), 18 (64.3%) had malignancy, and 10 (35.7%) had non-malignant obstruction. Although Eckardt score did not differentiate pseudoachalasia from 58 achalasia patients (55.9 ± 2.5 years, 53.4% female), weight loss was greater (median 9.1 [5.0-18.5] vs 3.6 [0-9.1] kg, P < .02) with shorter duration of symptoms (median 12.9 [8.0-38.6] vs 36.0 [25.7-45.0] weeks, P < .001] in pseudoachalasia. Esophagogastric junction (EGJ) metrics demonstrated lower mean IRP values and lower EGJ contractile integral in pseudoachalasia (P < .04 for each comparison with idiopathic achalasia). Type 1 pattern was more frequent in pseudoachalasia (39.3% vs 13.8%, P < .008). Pseudoachalasia demonstrated incomplete HRM patterns, with lower rates of lack of peristalsis (79.6%, vs 93.1% in achalasia, P < .05). Despite higher Eckardt scores in malignant vs non-malignant pseudoachalasia (median 8.0 [7.0-9.0] vs 6.0 [3.5-7.8], P < .03], no significant HRM differences were noted.
CONCLUSIONS AND INFERENCES
Pseudoachalasia manifests with a shorter history, greater weight loss, and incomplete HRM achalasia patterns compared to achalasia.
背景
假性贲门失弛缓症的高分辨率测压（HRM）结果表现为贲门失弛缓症，但这是继发于其他原因。我们分析了假性贲门失弛缓症的临床和 HRM 特征，包括恶性和非恶性亚型。
方法
回顾性分析经证实的假性贲门失弛缓症患者的 HRM 结果，并结合内镜和影像学研究进行证实。确定了特发性贲门失弛缓症的对照组。从机构记录中提取临床特征、Eckardt 评分和 HRM 指标。使用参数和非参数统计检验比较假性贲门失弛缓症与特发性贲门失弛缓症、恶性与非恶性假性贲门失弛缓症之间的组间数据和中位数（四分位距）。
主要结果
在 28 例假性贲门失弛缓症患者（62.2±2.5 岁，60.7%为女性）中，18 例（64.3%）存在恶性肿瘤，10 例（35.7%）存在非恶性梗阻。尽管 Eckardt 评分不能区分假性贲门失弛缓症与 58 例贲门失弛缓症患者（55.9±2.5 岁，53.4%为女性），但假性贲门失弛缓症患者的体重减轻更明显（中位数 9.1[5.0-18.5] vs 3.6[0-9.1]kg，P<.02），症状持续时间更短（中位数 12.9[8.0-38.6] vs 36.0[25.7-45.0]周，P<.001）。食管胃交界处（EGJ）的测量值显示假性贲门失弛缓症的平均 IRP 值较低，EGJ 收缩积分较低（与特发性贲门失弛缓症相比，每项比较均 P<.04）。假性贲门失弛缓症中 1 型模式更为常见（39.3% vs 13.8%，P<.008）。假性贲门失弛缓症表现为不完全的 HRM 模式，蠕动缺失的发生率较低（79.6%，vs 贲门失弛缓症 93.1%，P<.05）。尽管恶性假性贲门失弛缓症的 Eckardt 评分更高（中位数 8.0[7.0-9.0] vs 6.0[3.5-7.8]，P<.03），但 HRM 无明显差异。
结论
与贲门失弛缓症相比，假性贲门失弛缓症的病史更短、体重减轻更多、HRM 贲门失弛缓症模式不完全。
Zotero 插件