Lin Gang-Hua, Lin Kuan-Hsun, Lin Szu-Yu, Huang Tsai-Wang, Chang Hung, Huang Hsu-Kai
Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan.
Division of Thoracic Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan.
J Pers Med. 2022 Apr 7;12(4):590. doi: 10.3390/jpm12040590.
Esophageal motility disorders account for a large proportion of nonobstructive dysphagia cases, which constitute a heterogeneous group of diagnoses that commonly result in peristaltic derangement and impaired relaxation of the lower esophageal sphincter. We performed a single-institution retrospective study enrolling consecutive patients with chief complaints of dysphagia who underwent HRIM from December 2014 to December 2019, and analyzed demographic, clinical, and manometric data using descriptive statistics. In total, 277 identified patients were included in the final analysis. Ineffective esophageal motility ( = 152, 24.5%) was the most common diagnosis by HRIM, followed by absent contractility, EGJ outflow obstruction, type II achalasia, and type I achalasia. Furthermore, surgery including exploratory, laparoscopic, and robotic myotomy, as well as POEM, is considered the most effective treatment for patients with non-spastic achalasia and EGJOO, due to its effective symptom palliation and prevention of disease progression; surgery also contributes to an obvious improvement of dysphagia compared with slightly less efficacy for other related symptoms. Our study aimed to elaborate the clinical characteristics of patients with nonobstructive dysphagia based on HRIM in a Taiwanese population, and to analyze the therapeutic outcomes of such patients who ultimately underwent surgical interventions.
食管动力障碍在非梗阻性吞咽困难病例中占很大比例,这些病例构成了一组异质性诊断,通常会导致蠕动紊乱和食管下括约肌松弛受损。我们进行了一项单机构回顾性研究,纳入了2014年12月至2019年12月期间因吞咽困难为主诉而接受高分辨率食管测压(HRIM)的连续患者,并使用描述性统计分析了人口统计学、临床和测压数据。最终分析共纳入了277例确诊患者。HRIM最常见的诊断是无效食管动力(n = 152,24.5%),其次是无收缩力、食管胃交界部流出道梗阻、II型贲门失弛缓症和I型贲门失弛缓症。此外,手术,包括探查性、腹腔镜和机器人肌切开术,以及经口内镜下肌切开术(POEM),被认为是治疗非痉挛性贲门失弛缓症和食管胃交界部流出道梗阻患者最有效的方法,因为它能有效缓解症状并预防疾病进展;与对其他相关症状的疗效略低相比,手术对吞咽困难也有明显改善。我们的研究旨在阐述台湾人群中基于HRIM的非梗阻性吞咽困难患者的临床特征,并分析最终接受手术干预的此类患者的治疗结果。