Type II achalasia with focal elevated pressures: A distinct manometric and clinical sub-group.

Autor: Low EE; Division of Gastroenterology, University of California San Diego, San Diego, California, USA., Fehmi SA; Division of Gastroenterology, University of California San Diego, San Diego, California, USA., Hasan A; Division of Gastroenterology, University of California San Diego, San Diego, California, USA., Chang M; Division of Gastroenterology, University of California San Diego, San Diego, California, USA., Kwong W; Division of Gastroenterology, University of California San Diego, San Diego, California, USA., Krinsky ML; Division of Gastroenterology, University of California San Diego, San Diego, California, USA., Anand G; Division of Gastroenterology, University of California San Diego, San Diego, California, USA., Greytak M; Division of Gastroenterology, University of California San Diego, San Diego, California, USA., Kaizer A; Department of Biostatistics & Informatics, University of Colorado, Denver, Colorado, USA., Carlson DA; Division of Gastroenterology, Northwestern University, Chicago, Illinois, USA., Pandolfino JE; Division of Gastroenterology, Northwestern University, Chicago, Illinois, USA., Yadlapati R; Division of Gastroenterology, University of California San Diego, San Diego, California, USA.
Jazyk: angličtina
Zdroj: Neurogastroenterology and motility [Neurogastroenterol Motil] 2022 Dec; Vol. 34 (12), pp. e14449. Date of Electronic Publication: 2022 Aug 16.
DOI: 10.1111/nmo.14449
Abstrakt: Background: 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.
Methods: 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.
Key Results: 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 (2.2mm 2 /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).
Conclusions and Inferences: 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.
(© 2022 John Wiley & Sons Ltd.)
Databáze: MEDLINE
Externí odkaz:
Nepřihlášeným uživatelům se plný text nezobrazuje