Furrukh Muhammad, Akhter Tayyab S, Rahman Fawad, Ayaz Fatima, Ambreen Saima
Department of Medicine, Holy Family Hospital, Rawalpindi, PAK.
Department of Gastroenterology and Hepatology, Holy Family Hospital, Rawalpindi, PAK.
Cureus. 2024 Jul 29;16(7):e65623. doi: 10.7759/cureus.65623. eCollection 2024 Jul.
Achalasia is a chronic and rare disorder of esophageal motility. It is characterized by spastic or absent esophageal contractions and impairment of relaxation of the lower esophageal sphincter. Treatment modalities include smooth muscle-relaxing medications, botulinum toxin injections to lower the esophageal sphincter, pneumatic dilatation, and surgical interventions. Pneumatic dilatation is deemed to be an effective treatment option and is the most widely used non-surgical intervention. We designed this prospective study to look for any possible correlation between balloon pressure used in pneumatic dilatation, manometric findings, and patient characteristics. And to find any possible association between the need for repeat pneumatic dilatations and factors like gender, age, duration of symptoms, Eckardt score, daily retrosternal pain, manometric findings, and balloon pressures. Thirty-one patients with confirmed achalasia were enrolled in the study. All of these patients underwent pneumatic dilatation. Pearson's correlation coefficient was found to be 0.234 (p-value 0.23) between the required balloon pressure and integrated relaxation pressure (IRP). Six of these patients required repeat pneumatic dilatations. No statistically significant association was noted between the need for repeat intervention and gender, age over 40, age under 20, Eckardt score over 10, daily chest pain, duration of symptoms over two years, and IRP over 30 mmHg. In conclusion, it could be said that pneumatic dilatation does not carry a 100% success rate, and repeat sessions are needed in many of the patients with achalasia. So, long-term follow-up is crucial. Managing expectations and making a realistic plan with proper informational care is important at the beginning of treatment.
贲门失弛缓症是一种慢性且罕见的食管动力障碍性疾病。其特征为食管痉挛或无收缩，以及食管下括约肌松弛功能受损。治疗方式包括平滑肌松弛药物、向食管下括约肌注射肉毒杆菌毒素、气囊扩张以及手术干预。气囊扩张被认为是一种有效的治疗选择，也是最广泛使用的非手术干预方法。我们设计了这项前瞻性研究，以寻找气囊扩张所用压力、测压结果与患者特征之间的任何可能关联。并找出重复气囊扩张的必要性与性别、年龄、症状持续时间、埃卡德特评分、每日胸骨后疼痛、测压结果及气囊压力等因素之间的任何可能关联。31例确诊为贲门失弛缓症的患者纳入本研究。所有这些患者均接受了气囊扩张。所需气囊压力与综合松弛压（IRP）之间的皮尔逊相关系数为0.234（p值0.23）。其中6例患者需要重复气囊扩张。在重复干预的必要性与性别、40岁以上年龄、20岁以下年龄、埃卡德特评分超过10分、每日胸痛、症状持续时间超过两年以及IRP超过30 mmHg之间未发现统计学上的显著关联。总之，可以说气囊扩张并非100%成功，许多贲门失弛缓症患者需要重复治疗。因此，长期随访至关重要。在治疗开始时，管理患者预期并通过适当的信息护理制定切实可行的计划很重要。
