Correlation between clinical severity score and the lower esophageal sphincter relaxation pressure in idiopathic achalasia

Yaghoobi, Mohammad; Mikaeli, Javad; Montazeri, Ghodratollah; Nouri, Negin; Sohrabi, Masoudreza; Malekzadeh, Reza

doi:10.1111/j.1572-0241.2003.07266.x

Cited by 28 publications

(17 citation statements)

References 18 publications

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“…Review of prior literature regarding correlation of symptoms with TBE or HRM findings shows inconsistent results . Andersson and colleagues reported an inverse correlation between TBE width and postprandial chest pain ( r = −0.44) .…”

Section: Discussionmentioning

confidence: 99%

Timed barium esophagram in achalasia types

Zanoni¹,

Rice²,

López³

et al. 2014

Dis Esophagus

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Relationships of timed barium esophagram (TBE) findings to achalasia types defined by high-resolution manometry (HRM) have not been elucidated. Therefore, we correlated preoperative TBE and HRM measurements in achalasia types and related these to patient symptoms and prior treatments. From 2006 to 2013, 248 achalasia patients underwent TBE and HRM before Heller myotomy. TBE height and width were recorded at 1 and 5 minutes; HRM measured lower esophageal sphincter mean basal pressure, integrated relaxation pressure (IRP), and mean esophageal body contraction amplitude. Achalasia was classified into types I (25%), II (65%), and III (9.7%). TBE height at 5 minutes was higher for I (median 8 cm; interquartile range 6-12) and II (8 cm; 8-11) than for III (1 cm; 0-7). TBE width at 5 minutes was widest (3 cm; 2-4), narrower in II (2 cm; 2-3), and narrowest in I (1 cm; 0-2), P < 0.001. Volume remaining at 1 and 5 minutes was lower in III (1 m(2) ; 0-16) than I (42 m(2) ; 17-106) and II (39 m(2) ; 15-60), highlighting poorer emptying of I and II. Increasing TBE width correlated with deteriorating morphology and function from III to II to I. Symptoms poorly correlated with TBE and HRM. Prior treatment was associated with less regurgitation, faster emptying, and lower IRP. Although TBE and HRM are correlated in many respects, the wide range of their measurements observed in this study reveals a spectrum of morphology and dysfunction in achalasia that is best characterized by the combination of these studies.

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Section: Discussionmentioning

confidence: 99%

Timed barium esophagram in achalasia types

Zanoni¹,

Rice²,

López³

et al. 2014

Dis Esophagus

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“…Symptomatic scoring has also been described, 29,85 although this is not an option in animal studies. Overall, most agree that a barium esophagogram coupled with fluoroscopy is the best approach for an accurate diagnosis of achalasia.…”

Section: Discussionmentioning

confidence: 99%

Megaesophagus in a Line of Transgenic Rats

et al. 2014

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Megaesophagus is defined as the abnormal enlargement or dilatation of the esophagus, characterized by a lack of normal contraction of the esophageal walls. This is called achalasia when associated with reduced or no relaxation of the lower esophageal sphincter (LES). To date, there are few naturally occurring models for this disease. A colony of transgenic (Pvrl3-Cre) rats presented with megaesophagus at 3 to 4 months of age; further breeding studies revealed a prevalence of 90% of transgene-positive animals having megaesophagus. Affected rats could be maintained on a total liquid diet long term and were shown to display the classic features of dilated esophagus, closed lower esophageal sphincter, and abnormal contractions on contrast radiography and fluoroscopy. Histologically, the findings of muscle degeneration, inflammation, and a reduced number of myenteric ganglia in the esophagus combined with ultrastructural lesions of muscle fiber disarray and mitochondrial changes in the striated muscle of these animals closely mimic that seen in the human condition. Muscle contractile studies looking at the response of the lower esophageal sphincter and fundus to electrical field stimulation, sodium nitroprusside, and L-nitro-L-arginine methyl ester also demonstrate the similarity between megaesophagus in the transgenic rats and patients with achalasia. No primary cause for megaesophagus was found, but the close parallel to the human form of the disease, as well as ease of care and manipulation of these rats, makes this a suitable model to better understand the etiology of achalasia as well as study new management and treatment options for this incurable condition.

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“…In this scoring system, scores for the following five symptoms; dysphagia to solids, dysphagia to liquids, passive regurgitation, active regurgitation, and chest pain are summed up to calculate the total score. In a study of 116 patients with achalasia, we found a good correlation between this score and LES pressure (r = 0.29, P < 0.01) [36] . Among the main symptoms, active and passive regurgitation and dysphagia to liquids were significantly correlated to the LES relaxation pressure (P = 0.001, 0.002, and 0.046, respectively) [36] .…”

Section: Symptomatic Scoringmentioning

confidence: 99%

Achalasia: A review of Western and Iranian experiences

Mikaeli¹,

Islami²,

Malekzadeh³

2009

WJG

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Achalasia is a primary motor disorder of the eso phagus, in which esophageal emptying is impaired. Diagnosis of achalasia is based on clinical findings. The diagnosis is confirmed by radiographic, endoscopic, and manometric evaluations. Several treatments for achalasia have been introduced. We searched the PubMed Database for original articles and meta analyses about achalasia to summarize the current knowledge regarding this disease, with particular focus on different procedures that are used for treatment of achalasia. We also report the Iranian experience of treatment of this disease, since it could be considered as a model for mediumresource countries. Myotomy, particularly laparoscopic myotomy with fundoplication, i s t h e m o s t e ffe c t i ve t re a t m e n t fo r a c h a l a s i a . Compared to other treatments, however, the initial cost of myotomy is usually higher and the recovery period is longer. When performing myotomy is not indicated or not possible, graded pneumatic dilation with slow rate of balloon inflation seems to be an effective and safe initial alternative. Injection of botulinum toxin into the lower esophageal sphincter before pneumatic dilation may increase remission rates. However, this needs to be confirmed in further studies. Due to lack of adequate information regarding the role of expandable stents in the treatment of achalasia, insertion of stents does not currently seem to be a recommended treatment. In summary, laparoscopic myotomy can be considered as the procedure of choice for treatment of achalasia. Graded pneumatic dilation is an effective alternative when the performance of myotomy is not possible for any reason.

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Correlation between clinical severity score and the lower esophageal sphincter relaxation pressure in idiopathic achalasia

Abstract: Our study showed that a clinical symptom score can be an appropriate predictor of the LES relaxation pressure in patients with idiopathic achalasia before therapy. Further studies are needed to evaluate similar correlations after therapeutic intervention.

Cited by 28 publications

References 18 publications

Timed barium esophagram in achalasia types

Timed barium esophagram in achalasia types

Megaesophagus in a Line of Transgenic Rats

Achalasia: A review of Western and Iranian experiences

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