Cohen Daniel L, Avivi Eyal, Bermont Anton, Shibli Fahmi, Azzam Narges, Hijazi Basem, Baker Fadi Abu, Richter Vered, Shirin Haim, Mari Amir
The Gonczarowski Family Institute of Gastroenterology and Liver Diseases, Shamir (Assaf Harofeh) Medical Center, Zerifin 703000, Israel.
Gastroenterology and Hepatology Institute, HaEmek Medical Center, Afula 1834111, Israel.
Diagnostics (Basel). 2023 Mar 16;13(6):1136. doi: 10.3390/diagnostics13061136.
Achalasia is characterized by aperistalsis with poor relaxation of the lower esophageal sphincter (LES). We aimed to systematically assess whether LES metrics on high-resolution manometry (HRM) correlate with the symptomatic or endoscopic presentation of patients with achalasia.
A retrospective study was performed at two tertiary medical centers. All cases of newly diagnosed, untreated achalasia were reviewed for demographics, symptoms, and endoscopic findings. These were correlated with HRM metrics, including LES basal pressure (LESP), integrated relaxation pressure (IRP), percent LES relaxation, and esophagogastric junction (EGJ) morphology.
108 achalasia patients were included; 56 (51.9%) were men, with a mean overall age of 55.6 ± 17.9 years old. Achalasia subtypes included 23.1% with Type I, 65.7% Type II, and 11.1% Type III. Mean LESP was 40.9 ± 13.7 mmHg, IRP 26.8 ± 11.5 mmHg, with 36% ± 20% LES relaxation. On univariate analyses, a higher IRP was associated with age < 50 ( = 0.028), female sex ( = 0.030), Arab ethnicity ( < 0.001), weight loss ( = 0.016), a tortuous esophagus ( = 0.036), and resistance at the EGJ ( = 0.033). However, on multivariate regression analyses, only ethnicity remained significantly associated with IRP. No unique variables were associated with either LESP or percent LES relaxation. Achalasia subtype and Eckardt score were not associated with any LES metrics. Non-Type 1 EGJ morphology was associated with a lower LESP.
LES metrics on HRM do not appear to correlate with the clinical or endoscopic presentation of patients with untreated achalasia.
贲门失弛缓症的特征是食管蠕动消失以及食管下括约肌（LES）松弛不良。我们旨在系统评估高分辨率测压法（HRM）测得的LES指标是否与贲门失弛缓症患者的症状或内镜表现相关。
在两家三级医疗中心进行了一项回顾性研究。对所有新诊断、未经治疗的贲门失弛缓症病例的人口统计学、症状和内镜检查结果进行了回顾。将这些结果与HRM指标进行关联，包括LES基础压力（LESP）、综合松弛压力（IRP）、LES松弛百分比以及食管胃交界处（EGJ）形态。
纳入了108例贲门失弛缓症患者；56例（51.9%）为男性，平均总年龄为55.6±17.9岁。贲门失弛缓症亚型包括I型占23.1%，II型占65.7%，III型占11.1%。平均LESP为40.9±13.7 mmHg，IRP为26.8±11.5 mmHg，LES松弛率为36%±20%。在单因素分析中，较高的IRP与年龄<50岁（P = 0.028）、女性（P = 0.030）、阿拉伯族裔（P<0.001）、体重减轻（P = 0.016）、食管迂曲（P = 0.036）以及EGJ处阻力（P = 0.033）相关。然而，在多因素回归分析中，只有族裔与IRP仍显著相关。没有独特变量与LESP或LES松弛百分比相关。贲门失弛缓症亚型和埃卡德特评分与任何LES指标均无关。非I型EGJ形态与较低的LESP相关。
HRM测得的LES指标似乎与未经治疗的贲门失弛缓症患者的临床或内镜表现无关。
