Department of General Internal Medicine 2, Kawasaki Medical School General Medical Center, Okayama, Japan.
Division of Endoscopy and Ultrasonography, Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School General Medical Center, 2-6-1 Nakasange Kita-ku, Okayama-city, Okayama, 7008505, Japan.
Esophagus. 2022 Apr;19(2):316-323. doi: 10.1007/s10388-021-00897-z. Epub 2021 Dec 3.
The rarity of esophageal achalasia has resulted in little being known about the characteristics of its three subtypes. The upper esophageal sphincter is considered one key factor to prevent aspiration pneumonia, a serious complication of esophageal achalasia. This study aimed to reveal the subtype characteristics of esophageal achalasia and how the upper esophageal sphincter functions and relates to other clinical parameters of the disease.
We retrospectively investigated the clinical records of patients diagnosed with esophageal achalasia. All participants underwent esophagogastroduodenoscopy and then, within 2 weeks, high-resolution manometry. Gastrointestinal symptoms were assessed using a previously validated self-reported questionnaire.
A total of 110 patients with esophageal achalasia were enrolled: 50 with type I, 40 with type II, and 20 with type III. Mean age at diagnosis was 54.5, 50.4, and 66.1 years for types I, II, and III, respectively. Mean resting upper esophageal sphincter pressure was 28.0, 51.8, and 43.6 mmHg for patients with types I, II, and III, respectively (p < 0.01). Patients with type III esophageal achalasia more frequently reported stomachache than those with type I (p = 0.03). A negative correlation between resting upper esophageal sphincter pressure and age was observed in all subtypes.
A negative correlation was confirmed between resting upper esophageal sphincter pressure and age in all subtypes of esophageal achalasia. Type III patients were older at diagnosis, type II patients showed higher upper esophageal sphincter pressure, and type I patients showed a lower upper esophageal sphincter pressure at the early life stage.
食管失弛缓症的罕见性导致人们对其三种亚型的特征知之甚少。上食管括约肌被认为是预防吸入性肺炎的一个关键因素，吸入性肺炎是食管失弛缓症的一种严重并发症。本研究旨在揭示食管失弛缓症的亚型特征，以及上食管括约肌的功能及其与疾病其他临床参数的关系。
我们回顾性调查了诊断为食管失弛缓症的患者的临床记录。所有参与者均接受了食管胃十二指肠镜检查，然后在 2 周内进行高分辨率测压。使用先前验证的自我报告问卷评估胃肠道症状。
共纳入 110 例食管失弛缓症患者：I 型 50 例，II 型 40 例，III 型 20 例。I、II 和 III 型的诊断年龄分别为 54.5、50.4 和 66.1 岁。I、II 和 III 型患者的静息上食管括约肌压力分别为 28.0、51.8 和 43.6mmHg（p<0.01）。III 型食管失弛缓症患者比 I 型患者更常报告胃痛（p=0.03）。在所有亚型中均观察到静息上食管括约肌压力与年龄之间存在负相关。
在所有食管失弛缓症亚型中均证实静息上食管括约肌压力与年龄之间存在负相关。III 型患者的诊断年龄较大，II 型患者的上食管括约肌压力较高，而 I 型患者在上食管括约肌压力较低的生命早期阶段。
