Identification of Achalasia Within Absent Contractility Phenotypes on High-Resolution Manometry: Prevalence, Predictive Factors, and Treatment Outcome.

IF 8 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY
American Journal of Gastroenterology Pub Date : 2024-11-01 Epub Date: 2024-02-01 DOI:10.14309/ajg.0000000000002694
Parth Patel, Benjamin D Rogers, Arvind Rengarajan, Benjamin Elsbernd, Elizabeth R O'Brien, C Prakash Gyawali
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Abstract

Introduction: Absent contractility on high-resolution manometry (HRM) defines severe hypomotility but needs distinction from achalasia. We retrospectively identified achalasia within absent contractility using HRM provocative maneuvers, barium esophagography, and functional lumen imaging probe (FLIP).

Methods: Adult patients with absent contractility on HRM during the 4-year study period were eligible for inclusion. Inadequate studies, achalasia after therapy, or prior foregut surgery were exclusions. Upright integrated relaxation pressure (IRP) >12 mm Hg, panesophageal pressurization, and/or elevated IRP on multiple rapid swallows and rapid drink challenge (RDC) were considered abnormal. Esophageal barium retention and abnormal esophagogastric junction distensibility index (<2.0 mm 2 /mm Hg) on FLIP defined achalasia. Clinical, endoscopic, and motor characteristics of patients with achalasia were compared with absent contractility without obstruction.

Results: Of 164 patients, 20 (12.2%) had achalasia (17.9% of 112 patients with adjunctive testing), while 92 did not, and 52 did not undergo adjunctive tests. Achalasia was diagnosed regardless of IRP value, but the median supine IRP was higher (odds ratio 1.196, 95% confidence interval 1.041-1.375, P = 0.012). Patients with achalasia were more likely to present with dysphagia (80.0% vs 35.9%, P < 0.001), with obstructive features on HRM maneuvers (83.3% vs 48.9%, P = 0.039), but lower likelihood of GERD evidence (20.0% vs 47.3%, P = 0.027) or large hiatus hernia (15.0% vs 43.8%, P = 0.002). On multivariable analysis, dysphagia presentation ( P = 0.006) and pressurization on RDC ( P = 0.027) predicted achalasia, while reflux and presurgical evaluations and lack of RDC obstruction predicted absent contractility without obstruction.

Discussion: Despite HRM diagnosis of absent contractility, achalasia is identified in more than 1 in 10 patients regardless of IRP value.

通过高分辨率测压鉴定无收缩表型中的贲门失弛缓症:发病率、预测因素和治疗效果。
目的:高分辨率测压法(HRM)显示的无收缩性定义为严重的肌张力减退,但需要与贲门失弛缓症加以区分。我们使用 HRM 挑衅性操作、食管钡餐造影和功能性管腔成像探针(FLIP)回顾性地鉴别了无收缩功能的贲门失弛缓症:设计:在 4 年的研究期间,通过 HRM 检查发现贲门失弛缓症的成年患者均符合纳入条件。研究不充分、治疗后出现贲门失弛缓症或曾接受前胃手术的患者不在研究范围内。直立 IRP>12 mmHg、食管泛压和/或多次快速吞咽(MRS)和快速饮水挑战(RDC)时 IRP 升高均视为异常。食管钡剂潴留和胃食管胀气指数(EGJ DIResults)异常:在 164 名患者中,20 人(12.2%)患有贲门失弛缓症(在 112 名接受辅助检查的患者中占 17.9%),92 人未患有贲门失弛缓症,52 人未接受辅助检查。无论 IRP 值如何,贲门失弛缓症均可确诊,但仰卧位 IRP 中位数更高(几率比 1.196,95% 置信区间 1.041-1.375,P=0.012)。贲门失弛缓症患者更容易出现吞咽困难(80.0% 对 35.9%,P=0.012):尽管 HRM 诊断为无收缩力,但无论 IRP 值如何,每 10 位患者中就有 1 位以上被确诊为贲门失弛缓症。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
American Journal of Gastroenterology
American Journal of Gastroenterology 医学-胃肠肝病学
CiteScore
11.40
自引率
5.10%
发文量
458
审稿时长
12 months
期刊介绍: Published on behalf of the American College of Gastroenterology (ACG), The American Journal of Gastroenterology (AJG) stands as the foremost clinical journal in the fields of gastroenterology and hepatology. AJG offers practical and professional support to clinicians addressing the most prevalent gastroenterological disorders in patients.
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