Combination of Symptom Profile, Endoscopic Findings, and Esophageal Mucosal Histopathology Helps to Differentiate Achalasia from Refractory Gastroesophageal Reflux Disease.
Combination of Symptom Profile, Endoscopic Findings, and Esophageal Mucosal Histopathology Helps to Differentiate Achalasia from Refractory Gastroesophageal Reflux Disease.
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DOI：
10.3390/diagnostics11122347
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发表时间：
2021-12-13
期刊：
影响因子：
--
通讯作者：
Tseng PH
中科院分区：
文献类型：
--
作者：
Yeh CC;Shun CT;Tseng LW;Chiang TH;Wu JF;Lee HC;Chen CC;Wang HP;Wu MS;Tseng PH
贲门失弛缓症是一种罕见的原发性食管运动障碍，经常被误诊为难治性胃食管反流病（GERD）。本研究旨在确定可能有助于区分这两种实体的临床和组织病理学特征。前瞻性纳入未经治疗的贲门失弛缓症患者和尽管接受质子泵抑制剂治疗≥8周但仍出现难治性反流症状的患者。所有患者均接受了经过验证的症状问卷、食管胃十二指肠镜活检和高分辨率阻抗测压（HRIM）。根据四个预先确定的组织学标准比较食管粘膜的组织病理学：基底细胞增生或乳头伸长、嗜酸性粒细胞浸润、瘀点形成和粘膜肌层（MM）肥大。与GERD患者相比，贲门失弛缓症患者有相似的反流症状，但Eckardt评分较高，糜烂性食管炎和食管裂孔疝较少，内镜下食管食物滞留较多，组织病理学上MM肥大和瘀点形成的发生率较高。基于Eckardt评分≥4、食管胃交界部形态正常或食管食物滞留、瘀点形成和MM肥大并存的多因素logistic回归，建立了贲门失弛缓症的最佳预测模型。因此，结合常规可获取的变量，包括 Eckardt 评分、内镜特征和通过食管粘膜活检获得的组织病理学，可以提供贲门失弛缓症的早期识别。
Achalasia, a rare primary esophageal motility disorder, is often misdiagnosed as refractory gastroesophageal reflux disease (GERD). This study is aimed to identify the clinical and histopathologic features that may help to differentiate these two entities. Patients with untreated achalasia and those with refractory reflux symptoms despite ≥8 weeks of proton-pump inhibitor treatment were enrolled prospectively. All patients underwent validated symptom questionnaires, esophagogastroduodenoscopy with biopsy, and high-resolution impedance manometry (HRIM). Histopathology of esophageal mucosa was compared based on four pre-determined histological criteria: basal cell hyperplasia or papillae elongation, eosinophilic infiltration, petechiae formation, and hypertrophy of the muscularis mucosae (MM). Compared with the GERD patients, patients with achalasia had similar reflux symptoms, but higher Eckardt scores, fewer erosive esophagitis and hiatal hernia, more esophageal food retention on endoscopy, and higher prevalence of hypertrophy of the MM and petechiae formation on histopathology. Multivariate logistic regression based on Eckardt score ≥4, normal esophagogastric junction morphology or esophageal food retention, and coexistence of petechiae formation and hypertrophy of the MM, established the best prediction model for achalasia. Therefore, combination of routinely accessible variables, including Eckardt score, endoscopic features, and histopathology obtained via esophageal mucosal biopsy, may provide an earlier identification of achalasia.
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影响因子：
4.7
作者：
Murakami, Masahiro;Simons, Michael
通讯作者：
Simons, Michael
影响因子：
9
作者：
CASSELLA, RR;SAYRE, GP;ELLIS, FH
通讯作者：
ELLIS, FH
影响因子：
3.6
作者：
Shaw, Michael;Dent, John;Johnsson, Folke
通讯作者：
Johnsson, Folke
DOI：
10.4103/sjg.sjg_459_17
发表时间：
2018-03
期刊：
Saudi journal of gastroenterology : official journal of the Saudi Gastroenterology Association
影响因子：
--
作者：
Feng X;Linghu E;Chai N;Ding H
通讯作者：
Ding H
影响因子：
3.5
作者：
Sadowski, D. C.;Ackah, F.;Svenson, L. W.
通讯作者：
Svenson, L. W.