Clinical predictors of achalasia

Ferri, Lorenzo; Cools-Lartigue, Jonathan; Cao, Jia; Miller, Larry S.; Mayrand, Serge; Fried, Gerald M.; Darling, Gail

doi:10.1111/j.1442-2050.2009.01006.x

Cited by 12 publications

(10 citation statements)

References 16 publications

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“…Following consent, patients completed: (i) questionnaires detailing demographics, symptom duration, and previous treatment; (ii) the Medical Outcomes Study 36‐item Short‐Form survey (SF‐36); and (iii) the Achalasia Severity Questionnaire (ASQ) and Measure of Achalasia Disease Severity (MADS). Both the ASQ and MADS are previously published symptom scores with higher scores indicating more severe symptoms . The MADS questionnaire evaluated dysphagia symptoms using a 3‐point Likert scale, pain with a 4‐point Likert scale, and heartburn with a 5‐point Likert scale.…”

Section: Methodsmentioning

confidence: 99%

Treatment choices and outcomes of patients with manometrically diagnosed achalasia

et al. 2015

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This prospective population-based study was designed to evaluate treatment choices in patients with new manometrically diagnosed achalasia and their outcomes. Patients referred to the esophageal function laboratory were enrolled after a new manometric diagnosis of achalasia. Patients completed an initial achalasia symptom score validated questionnaire on their symptom severity, duration, treatment pre-diagnosis and Medical Outcomes Study 36-item Short-Form (SF-36) survey. Treatment decisions were made by the referring physician and the patient. Follow-up questionnaires were completed every 3 months for 1 year. Patients who chose not to undergo treatment at 1-year follow-up completed another questionnaire after 5 years. Between January 2004 and January 2005, 83 of 124 eligible patients were enrolled. Heller myotomy was performed on 31 patients, three patients received botulinum toxin injections, and 25 patients received 29 pneumatic balloon dilatations. Twenty-four patients chose to receive no treatment. Following treatment, patients treated with surgery, dilatation and botulinum toxin had an average improvement in achalasia symptom score of 23 +/- 12.2, 17 +/- 10.9, and 9 +/- 14, respectively. Patients receiving no treatment had worsening symptoms with a symptom score change of -3.5 +/- 11.4. Surgery and dilatation resulted in significant improvement (P < 0.01) relative to no treatment. In univariate logistic regression, symptom severity score (odds ratio [OR] 1.04, 95% confidence interval [CI] 1.00 to 1.08), sphincter tone (OR 1.04, 95% CI 1.00 to 1.09), difficulty swallowing liquids (OR 3.21, 95% 1.15 to 8.99), waking from sleep (OR 2.75, 95% 1.00 to 7.61), and weight loss (OR 5.99, 95% CI 1.93 to 18.58) were all significant in predicting that patients would select treatment. In the multivariate analysis, older age (OR 1.05, 95% CI 1.01 to 1.09) and weight loss (OR 3.91, 95% CI 1.02 to 15.2) were statistically significant for undergoing treatment. At 5 years, five (21%) of those who had initially declined treatment at 1 year ultimately chose a treatment. Patients who finally chose Heller myotomy had lower mental component dimension scores on the SF-36 at 1 year than those who did not. This study shows that almost one third of patients with manometrically diagnosed achalasia choose not to undergo treatment within 1 year of their diagnosis. Patients who are more symptomatic appear to be more likely to undergo treatment by univariate analysis. In multivariate analysis, increasing age and weight loss are predictive of those who will undergo treatment, with weight loss having the greatest influence. Patients who choose not to undergo treatment make lifestyle changes to maintain their quality of life, and only a minority of them ultimately undergo treatment.

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Section: Methodsmentioning

confidence: 99%

Treatment choices and outcomes of patients with manometrically diagnosed achalasia

et al. 2015

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“…The predictors of therapeutic failure for endoscopic pneumatic dilatation are younger age (40-45 years), male, dilated oesophagus, use of a small sized balloon (30 mm), repeated dilatations and a post dilatation LES pressure > 10 mmHg 12-14. The subtypes of achalasia cardia show variable response to endoscopic pneumatic dilatation.…”

Section: Introductionmentioning

confidence: 99%

Achalasia Cardia Subtyping by High-Resolution Manometry Predicts the Therapeutic Outcome of Pneumatic Balloon Dilatation

Pratap¹,

Kalapala²,

Darisetty³

et al. 2011

J Neurogastroenterol Motil

181

125

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Background/AimsHigh-resolution manometry (HRM) with pressure topography is used to subtype achalasia cardia, which has therapeutic implications. The aim of this study was to compare the clinical characteristics, manometric variables and treatment outcomes among the achalasia subtypes based on the HRM findings.MethodsThe patients who underwent HRM at the Asian Institute of Gastroenterology, Hyderabad between January 2008 and January 2009 were enrolled. The patients with achalasia were categorized into 3 subtypes: type I - achalasia with minimum esophageal pressurization, type II - achalasia with esophageal compression and type III - achalasia with spasm. The clinical and manometric variables and treatment outcomes were compared.ResultsEighty-nine out of the 900 patients who underwent HRM were diagnosed as achalasia cardia. Fifty-one patients with a minimum follow-up period of 6 months were included. Types I and II achalasia were diagnosed in 24 patients each and 3 patients were diagnosed as type III achalasia. Dysphagia and regurgitation were the main presenting symptoms in patients with types I and II achalasia. Patients with type III achalasia had high basal lower esophageal sphincter pressure and maximal esophageal pressurization when compared to types I and II. Most patients underwent pneumatic dilatation (type I, 22/24; type II, 20/24; type III, 3/3). Patients with type II had the best response to pneumatic dilatation (18/20, 90.0%) compared to types I (14/22, 63.3%) and III (1/3, 33.3%).ConclusionsThe type II achalasia cardia showed the best response to pneumatic dilatation.

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“…Barium esophagram may be useful as the initial test to map the esophagus when the clinician judges the patient to be at high risk of perforation on EGD, such as those with suspected high-risk lesions or strictures high up in the esophagus (66, 67). Performing both tests can provide complementary information in some situations, such as pre-operative assessment of Zenker’s diverticulum (68) or the assessment of suspected achalasia if manometry is not readily available (69).…”

Section: Recommendation Statementsmentioning

confidence: 99%

Clinical Practice Guidelines for the Assessment of Uninvestigated Esophageal Dysphagia

Liu

Andrews

Armstrong

et al. 2018

Journal of the Canadian Association of Gastroenterology

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Background and aims Our aim is to review the literature and provide guidelines for the assessment of uninvestigated dysphagia. Methods A systematic literature search identified studies on dysphagia. The quality of evidence and strength of recommendations were rated according to the Grading of Recommendation Assessment, Development, and Evaluation (GRADE) approach. Statements were discussed and revised via small group meetings, teleconferences, and a web-based platform until consensus was reached by the full group. Results The consensus includes 13 statements focused on the role of strategies for the assessment of esophageal dysphagia. In patients presenting with dysphagia, oropharyngeal dysphagia should be identified promptly because of the risk of aspiration. For patients with esophageal dysphagia, history can be used to help differentiate structural from motility disorders and to elicit alarm features. An empiric trial of proton pump inhibitor therapy should be limited to four weeks in patients with esophageal dysphagia who have reflux symptoms and no additional alarm features. For patients with persistent dysphagia, endoscopy, including esophageal biopsy, was recommended over barium esophagram for the assessment of structural and mucosal esophageal disease. Barium esophagram may be useful when the availability of endoscopy is limited. Esophageal manometry was recommended for diagnosis of esophageal motility disorders, and high-resolution was recommended over conventional manometry. Conclusions Once oropharyngeal dysphagia is ruled out, patients with symptoms of esophageal dysphagia should be assessed by history and physical examination, followed by endoscopy to identify structural and inflammatory lesions. If these are ruled out, then manometry is recommended for the diagnosis of esophageal dysmotility.

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Clinical predictors of achalasia

Cited by 12 publications

References 16 publications

Treatment choices and outcomes of patients with manometrically diagnosed achalasia

Treatment choices and outcomes of patients with manometrically diagnosed achalasia

Achalasia Cardia Subtyping by High-Resolution Manometry Predicts the Therapeutic Outcome of Pneumatic Balloon Dilatation

Clinical Practice Guidelines for the Assessment of Uninvestigated Esophageal Dysphagia

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