Kumar Binit, Dey Deepanjan, Kumar Dharmendra, Sharma P K
Assistant Professor, Department of Physiology, Armed Forces Medical College, Pune, India.
Professor, Department of Physiology, Armed Forces Medical College, Pune, India.
Med J Armed Forces India. 2024 Dec;80(Suppl 1):S210-S216. doi: 10.1016/j.mjafi.2023.07.006. Epub 2023 Oct 10.
Achalasia is characterized by failure of relaxation of the lower oesophageal sphincter (LOS) and abnormal peristalsis during swallowing. The study aimed to observe the effects of intervention in three sub-types of achalasia and compare the intervention outcomes among the three sub-types.
Forty-one patients underwent Eckardt scoring for severity of achalasia, followed by high-resolution manometry (HRM). After three and six months of intervention (pneumatic dilatation or 'Heller's Cardiomyotomy), Eckardt scoring and HRM were repeated and compared with the initial results.
Out of the 41 patients, 13 were diagnosed with type I achalasia (31.71%), 18 with type II (43.90%), and 10 with type III (24.39%). Significant differences between the pre- and post-intervention values of median integrated relaxation pressure (IRP) and Eckardt score were found in all three sub-types. Although the beneficial effect of intervention lasted up to six months postintervention, it was less than three months postintervention values. The intervention success rates were highest for both laparoscopic Heller's myotomy (LHM) and pneumatic dilatation (PD) in Type II Achalasia at three and six months postintervention, respectively.
One-time intervention is effective in all three sub-types. This benefit tends to taper over time but remains significant after six months of intervention. Type II Achalasia shows the best intervention outcomes compared to the other two sub-types at three months and six months post-intervention. Type III Achalasia shows the least response compared to other sub-types and is the poorest responder to intervention. The benefit of one-time intervention also deteriorates most in type III achalasia at the end of six months.
贲门失弛缓症的特征是食管下括约肌（LOS）松弛失败以及吞咽时蠕动异常。本研究旨在观察对三种贲门失弛缓症亚型进行干预的效果，并比较这三种亚型之间的干预结果。
41例患者接受了贲门失弛缓症严重程度的埃卡德特评分，随后进行高分辨率测压（HRM）。在干预（气囊扩张或“ heller贲门肌切开术”）3个月和6个月后，重复进行埃卡德特评分和HRM，并与初始结果进行比较。
41例患者中，13例被诊断为I型贲门失弛缓症（31.71%），18例为II型（43.90%），10例为III型（24.39%）。在所有三种亚型中，干预前后的中位综合松弛压（IRP）和埃卡德特评分值均存在显著差异。尽管干预的有益效果在干预后持续长达6个月，但低于干预后3个月的值。在干预后3个月和6个月时，II型贲门失弛缓症的腹腔镜 heller肌切开术（LHM）和气囊扩张术（PD）的干预成功率分别最高。
一次性干预对所有三种亚型均有效。这种益处会随着时间逐渐减弱，但在干预6个月后仍很显著。与其他两种亚型相比，II型贲门失弛缓症在干预后3个月和6个月时显示出最佳的干预结果。与其他亚型相比，III型贲门失弛缓症的反应最小，对干预的反应最差。在6个月末，一次性干预的益处也在III型贲门失弛缓症中恶化得最严重。
