Tracey J P, Traube M
Gastroenterology Unit, Yale University School of Medicine, New Haven, Connecticut.
Am J Gastroenterol. 1994 Nov;89(11):2014-8.
We undertook this study to determine the utility of various clinical findings and tests in the diagnosis of pseudoachalasia.
We reviewed the clinical, endoscopic, esophagographic, CT, and manometric findings of five patients with pseudoachalasia of malignancy. These patients were identified from our large group of 206 patients with manometrically diagnosed achalasia who were seen over the past 8 yr. For each pseudoachalasia patient, the two consecutively seen patients with idiopathic achalasia were chosen to comprise a control group.
The pseudoachalasia patients, as compared to the control group, had shorter duration of dysphagia (9.6 +/- 8.6 months vs 54.3 +/- 44.2 months, p < 0.05). They had similar weight loss (15.6 +/- 12.8 lbs vs 14.3 +/- 18.4 lbs, p = NS), but weight loss/time, where time is months of symptoms, was greater in the pseudoachalasia group (1.8 +/- 1.8 lbs/month vs 0.5 +/- 0.5 lbs/month, p < 0.05). There was, however, substantial overlap between the groups in all these parameters. Barium esophagography failed to reveal cancer in any of the pseudoachalasia patients. There was difficult passage of the endoscope through the gastroesophageal junction in all patients with pseudoachalasia, but endoscopic biopsy diagnosed cancer in only two of them. CT scans gave no clear evidence of malignancy in any patient, although three scans had nonspecific findings that, in retrospect, probably indicated malignancy. There were no distinguishing manometric findings.
When pseudoachalasia is suspected on the basis of a constellation of findings, such as advanced age, rapid weight loss, and difficulty in passing the endoscope through the gastroesophageal junction of a nondilated esophagus, negative findings on biopsy and CT scans should not lead to a false reassurance of a benign disorder, and repeated biopsy and scans or surgical exploration may lead to the diagnosis of pseudoachalasia.
我们开展这项研究以确定各种临床发现和检查在假性贲门失弛缓症诊断中的效用。
我们回顾了5例恶性假性贲门失弛缓症患者的临床、内镜、食管造影、CT和测压结果。这些患者是从我们过去8年中诊治的206例经测压诊断为贲门失弛缓症的大样本患者中识别出来的。对于每例假性贲门失弛缓症患者，选择连续就诊的2例特发性贲门失弛缓症患者作为对照组。
与对照组相比，假性贲门失弛缓症患者吞咽困难持续时间较短（9.6±8.6个月对54.3±44.2个月，p<0.05）。他们的体重减轻情况相似（15.6±12.8磅对14.3±18.4磅，p=无显著性差异），但体重减轻/时间（时间以症状持续月数计）在假性贲门失弛缓症组更大（1.8±1.8磅/月对0.5±0.5磅/月，p<0.05）。然而，所有这些参数在两组之间都有很大重叠。食管钡餐造影未在任何假性贲门失弛缓症患者中发现癌症。所有假性贲门失弛缓症患者的内镜通过胃食管交界处均困难，但内镜活检仅在其中2例中诊断出癌症。CT扫描在任何患者中均未给出明确的恶性肿瘤证据，尽管3次扫描有非特异性表现，回顾来看可能提示恶性肿瘤。测压结果无鉴别意义。
当根据一系列表现（如高龄、快速体重减轻以及内镜通过非扩张食管的胃食管交界处困难）怀疑假性贲门失弛缓症时，活检和CT扫描的阴性结果不应导致对良性疾病的错误放心，重复活检、扫描或手术探查可能会得出假性贲门失弛缓症的诊断。
