Abbas Sameen, Akhtar Tayyab S, Chinnam Sampath, Mushtaq Saima, Ahmad Nafees, Fang Yu, Khan Amjad
Department of Pharmacy Quaid-i-Azam University Islamabad Pakistan.
Center for Liver and Digestive Diseases Holy Family Hospital Rawalpindi Pakistan.
JGH Open. 2025 Mar 18;9(3):e70041. doi: 10.1002/jgh3.70041. eCollection 2025 Mar.
High-resolution manometry (HRM) is a gold standard for diagnosing achalasia and identification of its subtypes, but data regarding its correlation with clinical, endoscopic, and radiological features in low-resource settings like Pakistan are limited. This study aims to identify and compare manometric parameters with other diagnostic parameters among achalasia subtypes in Pakistani population.
A retrospective analysis of clinical, endoscopic, and radiological features of 381 patients who underwent HRM at Center for Liver and Digestive Diseases, Holy Family Hospital, Rawalpindi, Pakistan, from December 2015 to February 2024 was performed. Based on the HRM criterion, 213 patients were identified and categorized into subtypes: 132 cases for type I and 64 and 17 for type II and III, respectively.
Patient demographics were similar across subtypes except for sex (male-dominant in types I and II, female-dominant in type III). Symptom duration was longest in type III (8 years vs. 4.1 years). Almost all patients had dysphagia; 83% reported regurgitation/weight loss, 71% chest pain, and 64% vomiting. The endoscopy results were normal in 40% of patients, and barium swallow was inconclusive in just 13% of achalasia patients. Type III exhibited the highest EGJ relaxation pressure and lowest LES pressure. Notably, all subtypes displayed elevated IRP, with type I showing highest value.
This study identified type I achalasia as the most prevalent subtype. While barium swallow and endoscopy showed limited diagnostic accuracy, HRM confirmed subtypes in all patients. Despite challenges with GERD-like symptoms and inconclusive findings, further research is warranted to investigate specific clinical features of each subtype, potentially attributing to personalized treatment strategies.
高分辨率测压法（HRM）是诊断贲门失弛缓症及其亚型的金标准，但在巴基斯坦等资源匮乏地区，关于其与临床、内镜及放射学特征相关性的数据有限。本研究旨在识别并比较巴基斯坦人群贲门失弛缓症各亚型的测压参数与其他诊断参数。
对2015年12月至2024年2月在巴基斯坦拉瓦尔品第圣家族医院肝脏与消化疾病中心接受HRM检查的381例患者的临床、内镜及放射学特征进行回顾性分析。根据HRM标准，识别出213例患者并分为各亚型：I型132例，II型64例，III型17例。
除性别外，各亚型患者的人口统计学特征相似（I型和II型以男性为主，III型以女性为主）。III型症状持续时间最长（8年 vs. 4.1年）。几乎所有患者都有吞咽困难；83%报告有反流/体重减轻，�1%有胸痛，64%有呕吐。40%的患者内镜检查结果正常，仅13%的贲门失弛缓症患者钡餐检查结果不明确。III型食管下括约肌（EGJ）松弛压最高，食管下括约肌（LES）压力最低。值得注意的是，所有亚型的综合松弛压（IRP）均升高，I型的值最高。
本研究确定I型贲门失弛缓症是最常见的亚型。虽然钡餐和内镜检查的诊断准确性有限，但HRM可确诊所有患者的亚型。尽管存在胃食管反流病样症状及检查结果不明确的挑战，但仍有必要进一步研究各亚型的具体临床特征，这可能有助于制定个性化治疗策略。
