2nd Internal Medicine Department, Emergency Clinic Country Hospital, Iuliu Hatieganu University of Medicine and Pharmacy, ClujNapoca, Romania.
2nd Medical Department, Emergency County Hospital, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.
J Gastrointestin Liver Dis. 2020 Oct 27;29(4):501-508. doi: 10.15403/jgld-2995.
The three manometric patterns of achalasia are considered by some authors as different stages in the evolution of the same disorder. The aims of our study were to characterize patients with achalasia, in order to find key differences supporting the idea of progression from one type to the other, and to assess the clinical evolution in time.
From 280 high resolution esophageal manometry recordings we selected unique patients with achalasia. A standardized questionnaire used prior to each manometry recorded their symptoms. Manometric parameters (resting lower esophageal sphincter (LES) pressure, 4s-integrated relaxation pressure (IRP), length of the esophagus, etc.) were recorded. Patients were contacted to establish the clinical evolution.
We identified 108 new achalasia cases (mean age 48.2±16.2 years, 52.8% type I, 42.6% type II), 52 (48.1%) women. Dysphagia (98.1%), cough (64.8%), belching (60.2%) and reflux symptoms (53.7%) were frequently reported. Patients with type I achalasia reported more often that dysphagia worsened, compared to type II patients (χ2=7.3, p =0.007). Age, duration of dysphagia, body mass index (p=0.067) and esophageal length were similar in type I and type II achalasia. Resting LES pressure (64.7±22.6 mmHg vs. 54.3±21.6 mmHg, p=0.019) and 4s-IRP (45.3±17.6 mmHg vs. 38.4±15.5 mmHg, p=0.036) were higher in type II compared to type I achalasia. Overweight patients had a lower LES resting pressure and 4s-IRP compared to lean subjects. After a mean follow-up of 36.8±13.4 months, 49 (45.3%) patients responded to our follow-up, and 77.5% had an Eckardt score ≤ 3.
Type I achalasia was the most common in our group. Type I patients had lower BMI but similar duration of dysphagia and mean age compared to type II. Type III is seldom and present in older patients. These findings suggest low probability of progression from type III and II to type I achalasia. Patients with type II achalasia had higher resting LES pressure and 4s-IRP than type I achalasia patients.
一些作者认为贲门失弛缓症的三种测压模式是同一疾病演变的不同阶段。我们研究的目的是对贲门失弛缓症患者进行特征描述，以发现从一种类型向另一种类型进展的关键差异，并评估其随时间的临床演变。
我们从 280 例高分辨率食管测压记录中选择了具有独特贲门失弛缓症的患者。在每次测压前使用标准化问卷记录他们的症状。记录测压参数（静息食管下括约肌压力（LES）、4s 整合松弛压力（IRP）、食管长度等）。与患者联系以确定临床演变。
我们确定了 108 例新贲门失弛缓症病例（平均年龄 48.2±16.2 岁，I 型 52.8%，II 型 42.6%），女性 52 例（48.1%）。经常报告吞咽困难（98.1%）、咳嗽（64.8%）、呃逆（60.2%）和反流症状（53.7%）。与 II 型患者相比，I 型患者更常报告吞咽困难恶化（χ2=7.3，p=0.007）。I 型和 II 型贲门失弛缓症患者的年龄、吞咽困难持续时间、体重指数（p=0.067）和食管长度相似。II 型贲门失弛缓症的静息 LES 压力（64.7±22.6mmHg 与 54.3±21.6mmHg，p=0.019）和 4s-IRP（45.3±17.6mmHg 与 38.4±15.5mmHg，p=0.036）均高于 I 型。超重患者的 LES 静息压力和 4s-IRP 低于瘦患者。平均随访 36.8±13.4 个月后，49 例（45.3%）患者对我们的随访做出了回应，77.5%的患者 Eckardt 评分≤3。
我们组中最常见的是 I 型贲门失弛缓症。与 II 型患者相比，I 型患者的 BMI 较低，但吞咽困难持续时间和平均年龄相似。III 型很少见，且发生在老年患者中。这些发现表明从 III 型和 II 型向 I 型贲门失弛缓症进展的可能性较低。II 型贲门失弛缓症患者的 LES 静息压力和 4s-IRP 高于 I 型患者。
