Duricek Martin, Baranovicova Eva, Demeter Michal, Vazanova Diana, Nosakova Lenka, Vojtko Marek, Kertys Martin, Lehotsky Jan, Halasova Erika, Banovcin Peter
Jessenius Faculty of Medicine in Martin, Clinic of Internal Medicine, Gastroenterology, Comenius University Bratislava, Mala Hora 4, 036 01, Martin, Slovakia.
Jessenius Faculty of Medicine in Martin, Biomedical Centre Martin, Comenius University Bratislava, Mala Hora 4, 036 01, Martin, Slovakia.
Metabolomics. 2025 Aug 11;21(5):109. doi: 10.1007/s11306-025-02303-6.
Achalasia is a rare motility disorder of the esophagus characterized by the loss of the propulsive peristalsis and impaired relaxation of the lower esophageal sphincter. Patients with untreated achalasia suffer from dysphagia and regurgitation and, consequently, weight loss as they require dietary modifications related to impaired esophageal emptying. Peroral endoscopic myotomy (POEM) is considered the mainstay of therapy, leading to symptom relief, restoration of normal eating patterns and weight gain.
This study aims to describe the metabolic state of an organism in time of insufficient nutrition and the relation among levels of systemic metabolites and changes in body's composition in condition of normalised food intake.
We monitored body composition, as well as biochemical parameters in 43 patients with achalasia before and 3 months after POEM intervention. We also determined the levels of circulating metabolites via NMR spectroscopy which were, besides comparison to controls, used to describe metabolic turnover before and after treatment.
After POEM, all patients except four individuals gained weight (p-value 3.07e-11), and accordingly, the BMI value changed (p-value 2.85e-9). Paired test revealed an increase in absolute fat (p-value 0.00176) and muscle mass (p-value 0.00201). Metabolic analysis in patients with untreated achalasia showed a ketotic-like state with inadequate glycolysis and gluconeogenesis, which partially normalized three months after POEM. Post-POEM muscle mass gain was positively (p < 0.05-0.0005) and increase in absolute fat mass was negatively correlated (p-value < 0.05-0.0005) with the levels of circulating amino acids before the intervention.
Our observations provide complex insight into the metabolic shifts after successful treatment of achalasia that is directly related to the changes in the body composition. The metabolic alterations were not detectable through standard biochemical tests suggesting that conventional diagnostics may not fully reflect the metabolic condition of patients with achalasia.
贲门失弛缓症是一种罕见的食管动力障碍性疾病，其特征为推进性蠕动丧失和食管下括约肌松弛受损。未经治疗的贲门失弛缓症患者会出现吞咽困难和反流症状，因此，由于食管排空受损需要调整饮食，患者会体重减轻。经口内镜下肌切开术（POEM）被认为是主要的治疗方法，可缓解症状、恢复正常饮食模式并使体重增加。
本研究旨在描述营养不足时机体的代谢状态，以及食物摄入量正常化情况下全身代谢物水平与身体成分变化之间的关系。
我们监测了43例贲门失弛缓症患者在POEM干预前和干预后3个月的身体成分以及生化参数。我们还通过核磁共振波谱法测定了循环代谢物水平，除了与对照组进行比较外，这些水平还用于描述治疗前后的代谢周转情况。
POEM治疗后，除4例患者外，所有患者体重均增加（p值为3.07e-11），相应地，体重指数（BMI）值也发生了变化（p值为2.85e-9）。配对检验显示绝对脂肪量增加（p值为0.00176），肌肉量增加（p值为0.00201）。未经治疗的贲门失弛缓症患者的代谢分析显示出类似酮症的状态，糖酵解和糖异生不足，POEM治疗3个月后部分恢复正常。干预前循环氨基酸水平与POEM治疗后肌肉量增加呈正相关（p<0.05 - 0.0005），与绝对脂肪量增加呈负相关（p值<0.05 - 0.0005）。
我们的观察结果为贲门失弛缓症成功治疗后的代谢变化提供了全面的见解，这些变化与身体成分的改变直接相关。通过标准生化检测无法检测到代谢改变，这表明传统诊断方法可能无法完全反映贲门失弛缓症患者的代谢状况。
