APPARENT COMPLETE LOWER ESOPHAGEAL SPHINCTER RELAXATION IN ACHALASIA
APPARENT COMPLETE LOWER ESOPHAGEAL SPHINCTER RELAXATION IN ACHALASIA
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DOI：
10.1016/0016-5085(86)90876-0
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发表时间：
1986-04-01
期刊：
影响因子：
29.4
通讯作者：
CASTELL, DO
中科院分区：
文献类型：
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作者：
KATZ, PO;RICHTER, JE;CASTELL, DO
23例患者中有7例(30%)在2年内出现临床和放射学表现的失弛缓症，进行了食道测压，显示无蠕动，但明显的下食道括约肌(LES)完全松弛。详细的临床和实验室评估表明，这些患者可能代表了早期的贲门失弛缓症。吞咽困难和体重减轻的持续时间明显较短(p<；0.05)，而与16名更传统的贲门失弛缓症患者相比，7名患者的LES压力相似。放射性核素食道固体排空研究中的同位素滞留显示正常人和失弛缓症患者之间排空的中等延迟。这组患者的LES松弛持续时间明显短于正常受试者(P<；0.01)。虽然这些患者的括约肌松弛是完全的，但在功能上是不够的，可能是这种缩短的持续时间的结果。标准测压导管的小尺寸也可能导致这一令人困惑的发现。在贲门失弛缓症的测压过程中可以看到明显的完全性LES松弛，不应排除其诊断。
Seven of 23 patients (30%) seen in 2 yr with clinical and radiologic manifestations of achalasia underwent esophageal manometry demonstrating aperistalsis but apparent complete lower esophageal sphincter (LES) relaxation. Detailed clinical and laboratory evaluation suggests these patients may represent an early stage of achalasia. Duration of dysphagia and weight loss were significantly less (p < 0.05), whereas LES pressure was similar in the 7 patients compared with the 16 more traditional achalasia patients. Isotope retention during radionuclide esophageal solid-emptying studies showed intermediate delay in emptying between normal subjects and achalasia patients. The duration of LES relaxation in this group was significantly shorter (p < 0.01) than in normal subjects. Although complete, sphincter relaxation in these patients is functionally inadequate and may be the result of this shortened duration. The small size of standard manometry catheters may also contribute to this confusing finding. Apparent complete LES relaxation may be seen during manometry in achalasia and should not exclude its diagnosis.