Ponce J, Garrigues V, Ramírez J J, Pascual S, Argüello L, Berenguer J
Servicio de Medicina Digestiva, Hospital La Fe, Valencia.
Gastroenterol Hepatol. 1996 May;19(5):235-9.
The relationship between the diameter of the esophageal body and the clinical profile of the disease and response to treatment was analyzed in 151 patients with idiopathic achalasia by pneumatic dilation of the cardias. Of the 151 patients, 46 presented an esophageal diameter < or = 3 cm (group I), 78 a diameter > 3 cm up to a maximum of 5 cm (group II) and 27 presented a diameter > 5 cm (group III). The result of pneumatic dilatation of the cardias under endoscopic control was analyzed in 117 patients with a minimum follow up of one year after the last dilatation session. Of all the clinical parameters studied, significant statistical differences were only found in group III in respect to the time of symptom evolution and the presence of regurgitation. Manometric data in basal pressure of the esophageal body and in contraction wave width were lower in groups I and III, respectively. The remaining variables were similar in the three groups although group III showed a trend to older age and the frequency of pulmonary complications with lesser thoracic pain and registry of a strict pattern. Endoscopic pneumatic dilation carried out in all the cases was effective in 83% of the patients and was similar in the three study groups. The rate of complications (perforation) was also similar. The therapeutic efficacy of pneumatic dilatation was accompanied by a significant reduction in esophageal diameter. It was concluded that the increase in esophageal diameter in idiopathic achalasia is associated with chronological, clinical and functional parameters which suggest greater disease evolution but do not determine significant changes in the therapeutic response to endoscopic pneumatic dilatation.
通过贲门气囊扩张术，对151例特发性贲门失弛缓症患者食管体直径与疾病临床特征及治疗反应之间的关系进行了分析。151例患者中，46例食管直径≤3 cm（I组），78例直径>3 cm至最大5 cm（II组），27例直径>5 cm（III组）。对117例患者在最后一次扩张术后至少随访一年，分析了内镜控制下贲门气囊扩张的结果。在所有研究的临床参数中，仅在III组中发现症状演变时间和反流情况存在显著统计学差异。I组和III组食管体基础压力和收缩波宽度的测压数据分别较低。三组中的其余变量相似，尽管III组显示出年龄较大的趋势以及肺部并发症的发生率较低，胸痛较轻且有严格模式记录。所有病例均进行的内镜气囊扩张术在83%的患者中有效，且在三个研究组中相似。并发症（穿孔）发生率也相似。气囊扩张术的治疗效果伴随着食管直径的显著减小。得出的结论是，特发性贲门失弛缓症中食管直径的增加与时间、临床和功能参数相关，这些参数表明疾病进展更大，但并未决定内镜气囊扩张术治疗反应的显著变化。
