A clinical study of peroral endoscopic myotomy reveals that impaired lower esophageal sphincter relaxation in achalasia is not only defined by high-resolution manometry
A clinical study of peroral endoscopic myotomy reveals that impaired lower esophageal sphincter relaxation in achalasia is not only defined by high-resolution manometry
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DOI：
10.1371/journal.pone.0195423
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发表时间：
2018-04-02
期刊：
影响因子：
3.7
通讯作者：
Terai, Shuji
中科院分区：
文献类型：
--
作者：
Sato, Hiroki;Takahashi, Kazuya;Terai, Shuji
背景与目的贲门失弛缓症是一种以食管下括约肌（LES）松弛受损为特征的食管动力障碍性疾病.在高分辨率测压（HRM）中，LES松弛受损定义为积分松弛压（IRP）升高。然而，在正常IRP范围内的贲门失弛缓症的一个新的类别已suggested.MethodsHRM进行使用Starlet设备和IRP阈值为26毫米汞柱。经口内镜下肌切开术（POEM）的病例诊断贲门失弛缓症使用既定的方法。在POEM期间，评估LES的组织学。随访2个月后operating.Results41例贲门失弛缓症（18名妇女，平均年龄53 - 18.6岁）。其中，27例被置于IRP >26 mmHg亚组（HRM上LES松弛受损），14例被置于IRP < 26 mmHg亚组（HRM上LES松弛正常）。在IRP < 26 mmHg的亚组中，患者年龄较大，症状持续时间较长，食道扩张较多。IRP < 26 mmHg亚组有相同的症状严重程度较高的IRP亚组和POEM显着改善症状和IRP，虽然四名患者仍然有严重的LES fibrosis.ConclusionsThe贲门失弛缓症的临床表现之间的差距人力资源管理定义的受损LES松弛，与年龄或疾病进展认为原因降低LES压力。POEM可以是一种可行的治疗选择，即使对于IRP正常的贲门失弛缓症病例也是如此。然而，重度LES纤维化患者需要更多关注治疗适应症。
Background and aimAchalasia is an esophageal motility disorder characterized by impaired lower esophageal sphincter (LES) relaxation. On high-resolution manometry (HRM), impaired LES relaxation is defined by elevated integrated relaxation pressure (IRP). However, a new category of achalasia within the normal IRP range has been suggested.MethodsHRM was performed using a Starlet device and an IRP threshold of 26 mmHg. Peroral endoscopic myotomy (POEM) was performed for cases of achalasia diagnosed using established methods. During POEM, the histology of the LES was assessed. Follow-up was performed 2 months post-operatively.ResultsForty-one patients with achalasia (18 women, mean age 53 18.6 years) were included. Among them, 27 were placed in the IRP >26 mmHg subgroup (impaired LES relaxation on HRM) and 14 in the IRP < 26 mmHg subgroup (normal LES relaxation on HRM). In the IRP < 26 mmHg subgroup, patients were older, had longer symptom duration, and had more esophageal dilation. The IRP < 26 mmHg subgroup had the same symptom severity as the higher IRP subgroup and POEM significantly improved symptoms and IRP, although four patients still had severe LES fibrosis.ConclusionsThe clinical presentation of achalasia has a gap between a HRM-defined impaired LES relaxation, with aging or disease progression considered reasons for a lowered LES pressure. POEM can be a feasible treatment option, even for cases of achalasia with a normal IRP. However, patients with severe LES fibrosis need more attention for the therapeutic indication.