Importance of Barium Swallow Test and Chest CT Scan for Correct Diagnosis of Achalasia in the Primary Care Setting
Importance of Barium Swallow Test and Chest CT Scan for Correct Diagnosis of Achalasia in the Primary Care Setting
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DOI：
10.1620/tjem.247.41
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发表时间：
2019-01-01
影响因子：
2.2
通讯作者：
Nakano, Toru
中科院分区：
文献类型：
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作者：
Ishii, Tadashi;Akaishi, Tetsuya;Nakano, Toru
食管失弛缓症是一种原因不明的以食管扩张受损和下食管括约肌不松弛为特征的疾病。疾病的临床表现是非特异性的（例如，体重减轻、呕吐和持续咳嗽）;即，疾病的早期诊断通常是困难的。已知延迟诊断疾病会损害患者的生活质量。需要识别可能导致诊断延迟的诊断因素。在这项研究中，我们收集了38例贲门失弛缓症患者的数据，并寻找与延迟诊断相关的诊断因素（即，>=从第一次医院就诊到诊断的6个月）。入组患者根据食管测压结果诊断为贲门失弛缓症，接受了手术切开术。因此，当第一次接触患者的医生没有及时进行吞钡试验（p < 0.0001）或胸部CT扫描（p < 0.01）时，贲门失弛缓症的诊断可能会延迟。在延迟诊断的患者（n = 15）中，没有一个在首次住院后6个月内接受过吞钡试验或胸部CT检查。根据纳入的38例患者，吞咽钡剂试验和胸部CT扫描诊断贲门失弛缓症的敏感性估计值高于80%，但内镜检查的敏感性仅为50-81%。为了避免贲门失弛缓症的延误诊断，除了常规内镜检查外，及时进行吞钡试验或胸部CT扫描似乎非常重要。
Esophageal achalasia is a disease characterized by the impaired esophageal peristalsis and non-relaxation of the lower esophageal sphincter muscle with unknown causes. Clinical manifestation of the disease is nonspecific (e.g., weight loss, vomiting, and persistent cough); namely, early diagnosis of the disease is often difficult. Delayed diagnosis of the disease is known to impair the patients' quality of life. Identifying the diagnostic factors that could cause diagnostic delay is needed. In this study, we collected data from 38 patients with achalasia and searched for diagnostic factors associated with delayed diagnosis (i.e., >= 6 months from the first hospital visit to diagnosis). The enrolled patients, diagnosed with achalasia based on esophageal manometry findings, had undergone surgical myotomy. As a result, the diagnosis of achalasia was likely to be delayed when the physician who had first contacted the patient did not perform a barium swallow test (p < 0.0001) or chest CT scan (p < 0.01) in a timely fashion. Among the patients with a delayed diagnosis (n = 15), none underwent a barium swallow test or chest CT within 6 months from their first hospital visit. The estimated sensitivities of diagnostic examinations for achalasia based on the enrolled 38 patients were higher than 80% for the barium swallow test and chest CT scan, but only 50-81% for endoscopy. To avoid the delayed diagnosis of achalasia, performing a barium swallow test or chest CT scan in a timely fashion, in addition to routine endoscopy, appears to be highly important.