Type II achalasia with focal elevated pressures: A distinct manometric and clinical sub-group.
Type II achalasia with focal elevated pressures: A distinct manometric and clinical sub-group.
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DOI：
10.1111/nmo.14449
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发表时间：
2022-12
影响因子：
3.5
通讯作者：
Yadlapati, Rena
中科院分区：
文献类型：
--
作者：
Low, Eric E.;Fehmi, Syed Abbas;Hasan, Aws;Chang, Michael;Kwong, Wilson;Krinsky, Mary L.;Anand, Gobind;Greytak, Madeline;Kaizer, Alexander;Carlson, Dustin A.;Pandolfino, John E.;Yadlapati, Rena
II型贲门失弛缓症(ACH_2)的高分辨率测压显示≥为30毫米汞柱，≥为20%的吞咽，这是ACH_2与其他贲门失弛缓症亚型的区别。在ACh 2中观察到了不同的测压特征，特征是局灶性压力升高(PEP频段内的局域/节段性压力≥70毫米汞柱)和/或高压缩压力(PEP≥70毫米汞柱)。本研究旨在检测Ach2亚组的临床和生理变量。这项为期3年(2019年1月至2022年1月)的单中心回顾性研究纳入了HRM患者中患有Ach2的成年人，他们在治疗前接受了内窥镜超声(EUS)、功能性管腔成像探头(Flip)和/或食道造影(BE)检查。患者被分成两个主要的亚组：Ach2无FEPS和Ach2有FEPS。使用非配对单变量分析比较这些亚组之间的人口统计学、临床和生理学数据。53例Ach2患者中，40例(75%)无FEPS，13例(25%)有FEPS。与无FEPS的Ach2亚组相比，有FEPS的Ach2亚组EUS显示远端食管环肌肉显著增厚(1.4 mm[SD0.9]vs.2.1[0.7]；p=0.02)，BE上三次收缩的发生率较高(46%vs.100%；p=0.0006)，较低的食管胃交界处扩张指数(2.2mm2/mm Hg0.9 vs.0.9[0.4])；P=0.0008)，以及更高的收缩压(31.0毫米汞柱[9.8]比55.4[18.8]；P=0.01)在60毫升的充盈翻转，以及更高的胸痛发生率埃克哈特评分(P=0.03)。我们在HRM上确定了II型贲门失弛缓症的一个独特的亚组，定义为II型贲门失弛缓症伴局灶性压力升高。这一亚组具有独特的痉挛特征，并可能受益于个性化的治疗方法。
Type II achalasia (Ach2) is distinguished from other achalasia sub-types by the presence of panesophageal pressurization (PEP) of ≥30 mmHg in ≥20% swallows on high-resolution manometry (HRM). Variable manometric features in Ach2 have been observed, characterized by focal elevated pressures (FEPs) (focal/segmental pressures ≥70 mmHg within the PEP band) and/or high compression pressures (PEP ≥70 mmHg). This study aimed to examine clinical and physiologic variables among sub-groups of Ach2. This retrospective single center study performed over 3 years (1/2019–1/2022) included adults with Ach2 on HRM who underwent endoscopic ultrasound (EUS), functional lumen imaging probe (FLIP), and/or barium esophagram (BE) prior to therapy. Patients were categorized into two overarching sub-groups: Ach2 without FEPs and Ach2 with FEPs. Demographic, clinical, and physiologic data were compared between these sub-groups utilizing unpaired univariate analyses. Of 53 patients with Ach2, 40 (75%) were without FEPs and 13 (25%) had FEPs. Compared with the Ach2 sub-group without FEPs, the Ach2 sub-group with FEPs demonstrated a significantly thickened distal esophageal circular muscle on EUS (1.4 mm [SD 0.9] vs. 2.1 [0.7]; p = 0.02), higher prevalence of tertiary contractions on BE (46% vs. 100%; p = 0.0006), lower esophagogastric junction distensibility index (2.2mm2/mmHg [0.9] vs 0.9 [0.4]; p = 0.0008) as well as higher distensive pressure (31.0 mmHg [9.8] vs. 55.4 [18.8]; p = 0.01) at 60 cc fill on FLIP, and higher prevalence of chest pain on Eckardt score (p = 0.03). We identified a distinct sub-group of type II achalasia on HRM, defined as type II achalasia with focal elevated pressures. This sub-group uniquely exhibits spastic features and may benefit from personalized treatment approaches.
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DOI：
10.1152/ajpgi.00365.2001
发表时间：
2002-06-01
影响因子：
4.5
作者：
Pehlivanov, N;Liu, JM;Mittal, RK
通讯作者：
Mittal, RK
影响因子：
3.5
作者：
Carlson DA;Kou W;Rooney KP;Baumann AJ;Donnan E;Triggs JR;Teitelbaum EN;Holmstrom A;Hungness E;Sethi S;Kahrilas PJ;Pandolfino JE
通讯作者：
Pandolfino JE
影响因子：
7.7
作者：
Gu, Li;Ouyang, Zhenghui;Liu, Deliang
通讯作者：
Liu, Deliang
影响因子：
3.5
作者：
Yadlapati R;Kahrilas PJ;Fox MR;Bredenoord AJ;Prakash Gyawali C;Roman S;Babaei A;Mittal RK;Rommel N;Savarino E;Sifrim D;Smout A;Vaezi MF;Zerbib F;Akiyama J;Bhatia S;Bor S;Carlson DA;Chen JW;Cisternas D;Cock C;Coss-Adame E;de Bortoli N;Defilippi C;Fass R;Ghoshal UC;Gonlachanvit S;Hani A;Hebbard GS;Wook Jung K;Katz P;Katzka DA;Khan A;Kohn GP;Lazarescu A;Lengliner J;Mittal SK;Omari T;Park MI;Penagini R;Pohl D;Richter JE;Serra J;Sweis R;Tack J;Tatum RP;Tutuian R;Vela MF;Wong RK;Wu JC;Xiao Y;Pandolfino JE
通讯作者：
Pandolfino JE
影响因子：
29.4
作者：
Park S;Zifan A;Kumar D;Mittal RK
通讯作者：
Mittal RK