Department of Surgery, Tohoku University School of Medicine, 1-1, Seiryomachi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan.
Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan.
Esophagus. 2022 Jan;19(1):182-188. doi: 10.1007/s10388-021-00875-5. Epub 2021 Sep 3.
With the development of high-resolution manometry (HRM) and peroral endoscopy, more patients with esophageal motility disorders (EMDs) including achalasia are diagnosed and treated. The characteristics of Japanese patients with EMDs are unknown and should be elucidated.
A large-scale database analysis was performed at seven high-volume centers in Japan. EMDs between 2010 and 2019 were analyzed.
A total of 1900 patients were diagnosed with treatment naïve achalasia on esophagography. A long disease history was related to the sigmoid and dilated esophagus, and patients' symptom severity declined as achalasia progressed to the sigmoid type. Among 1700 patients received starlet HRM, 1476 (86.8%) completed the examination. Long disease history and sigmoid achalasia were identified as risk factors for the failure of HRM examination. Type I achalasia was the most common type found on starlet HRM, and 45.1% of patients with achalasia had lower esophageal sphincter (LES) pressure within the normal range. Type III had a high age of onset and mild symptom severity, compared to the other two subtypes. Type III achalasia, esophagogastric outflow obstruction (EGJ-OO), jackhammer esophagus (JE), and diffuse esophageal spasm (DES) were relatively rare compared to type I-II achalasia. The clinical characteristics of EGJ-OO, JE, and DES were generally close to those of achalasia.
This first large-scale database analysis indicates that more Japanese patients with achalasia are type I and have a normal range of LES pressure on starlet HRM. Failure of HRM is not rare; therefore, esophagography continuously has a complementary role in achalasia diagnosis.
随着高分辨率测压（HRM）和经口内镜的发展，越来越多的食管动力障碍（EMD）患者，包括贲门失弛缓症，得到了诊断和治疗。日本 EMD 患者的特点尚不清楚，需要加以阐明。
在日本的 7 个大容量中心进行了一项大规模的数据库分析。分析了 2010 年至 2019 年间的 EMD 患者。
1900 名患者在食管造影上被诊断为未经治疗的贲门失弛缓症。较长的病史与乙状结肠和扩张的食管有关，随着贲门失弛缓症向乙状结肠型发展，患者的症状严重程度下降。在接受星状 HRM 检查的 1700 名患者中，有 1476 名（86.8%）完成了检查。较长的病史和乙状结肠型贲门失弛缓症被确定为 HRM 检查失败的危险因素。在星状 HRM 上发现的最常见类型是 I 型贲门失弛缓症，45.1%的贲门失弛缓症患者的食管下括约肌（LES）压力在正常范围内。与其他两种亚型相比，III 型贲门失弛缓症的发病年龄较高，症状较轻。III 型贲门失弛缓症、食管胃出口梗阻（EGJ-OO）、痉挛性食管（JE）和弥漫性食管痉挛（DES）的发病率相对较低，与 I-II 型贲门失弛缓症相比。EGJ-OO、JE 和 DES 的临床特征通常与贲门失弛缓症相似。
这是首次对日本贲门失弛缓症患者进行的大规模数据库分析，表明更多的日本贲门失弛缓症患者为 I 型，且在星状 HRM 上 LES 压力处于正常范围。HRM 检查失败并不罕见；因此，食管造影在贲门失弛缓症的诊断中仍然具有补充作用。
