Ethnic Differences in Clinical Presentations and Esophageal High-Resolution Manometry Findings in Patients with Achalasia

Cohen, Daniel L.; Hijazi, Basem; Omari, Ali; Bermont, Anton; Shirin, Haim; Ahmad, Helal Said; Azzam, Narjes; Shibli, Fahmi; Dickman, Ram; Mari, Amir

doi:10.1007/s00455-022-10549-8

Cited by 3 publications

(3 citation statements)

References 34 publications

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“…This study reinforces associations between achalasia and LES traversal failure, as similar rates are reported in this study to that performed by Hengehold et al 9 . This study reinforces the association between ED and LES traversal failure described by Cohen et al., 10 and this study does so with consecutive patients.…”

Section: Discussionsupporting

confidence: 92%

“…8,9 Failure to pass the lower esophageal sphincter (LES) or full EGJ with the HREM catheter has been associated with structural abnormalities of the esophagus causing obstruction, like large hiatal hernias, epiphrenic diverticula (ED), and achalasia in different studies. 9,10 In these patients, esophageal motility evaluation must be made with different studies. Alternatives include HREM catheter placement with EGD assistance, endoscopic functional lumen imaging probe (FLIP), or barium esophagram.…”

Section: Introductionmentioning

confidence: 99%

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Nasopharyngeal airway assistance improves esophageal intubation rates of high‐resolution esophageal manometry catheters

Leopold,

Wu,

Xie

2024

Neurogastroenterology Motil

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BackgroundHigh‐resolution esophageal manometry (HREM) is the gold standard test for esophageal motility disorders. Nasopharyngeal airway‐assisted insertion of the HREM catheter is a suggested salvage technique for failure from the inability to pass the catheter through the upper esophageal sphincter (UES). It has not been demonstrated that the nasopharyngeal airway improves procedural success rate.MethodsPatients undergoing HREM between March 2019 and March 2023 were evaluated. Chart review was conducted for patient factors and procedural success rates before and after use of nasopharyngeal airway. Patients from March 2019 to May 2021 did not have nasopharyngeal airway available and were compared to patients from May 2021 to March 2023 who had the nasopharyngeal airway available.Key ResultsIn total, 523 HREM studies were conducted; 234 occurred prior to nasopharyngeal airway availability, and 289 occurred with nasopharyngeal airway availability. There was no difference in HREM catheter UES intubation rates between periods when a nasopharyngeal airway attempt was considered procedural failure (85% vs. 85%, p = 0.9). Nasopharyngeal airway use after UES intubation failure lead to improved UES intubation rates (94% vs. 85%, p < 0.01). Thirty‐six patients that failed HREM catheter UES intubation had the procedure reattempted with a nasopharyngeal airway, 30 (83%) of which were successful. The nasopharyngeal airway assisted catheter UES intubation for failures attributed to nasal pain and hypersensitivity, gagging, coughing, and pharyngeal coiling.Conclusions & InferencesUtilization of the nasopharyngeal airway increased rates of UES intubation. When HREM catheter placement through the UES fails, placement of a nasopharyngeal airway can be trialed to overcome patient procedural intolerance.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Nasopharyngeal airway assistance improves esophageal intubation rates of high‐resolution esophageal manometry catheters

Leopold,

Wu,

Xie

2024

Neurogastroenterology Motil

View full text Add to dashboard Cite

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“…The reason for this is unclear, but it may be related to genetic variations in immunogenic HLA haplotypes that have been reported in achalasia populations [ 15 , 16 ]. Future studies evaluating the role of ethnicity and genetics in achalasia patients are certainly warranted [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

Correlation between Lower Esophageal Sphincter Metrics on High-Resolution Manometry and the Clinical Presentation of Patients with Newly Diagnosed Achalasia

et al. 2023

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Background: Achalasia is characterized by aperistalsis with poor relaxation of the lower esophageal sphincter (LES). We aimed to systematically assess whether LES metrics on high-resolution manometry (HRM) correlate with the symptomatic or endoscopic presentation of patients with achalasia. Methods: A retrospective study was performed at two tertiary medical centers. All cases of newly diagnosed, untreated achalasia were reviewed for demographics, symptoms, and endoscopic findings. These were correlated with HRM metrics, including LES basal pressure (LESP), integrated relaxation pressure (IRP), percent LES relaxation, and esophagogastric junction (EGJ) morphology. Results: 108 achalasia patients were included; 56 (51.9%) were men, with a mean overall age of 55.6 ± 17.9 years old. Achalasia subtypes included 23.1% with Type I, 65.7% Type II, and 11.1% Type III. Mean LESP was 40.9 ± 13.7 mmHg, IRP 26.8 ± 11.5 mmHg, with 36% ± 20% LES relaxation. On univariate analyses, a higher IRP was associated with age < 50 (p = 0.028), female sex (p = 0.030), Arab ethnicity (p < 0.001), weight loss (p = 0.016), a tortuous esophagus (p = 0.036), and resistance at the EGJ (p = 0.033). However, on multivariate regression analyses, only ethnicity remained significantly associated with IRP. No unique variables were associated with either LESP or percent LES relaxation. Achalasia subtype and Eckardt score were not associated with any LES metrics. Non-Type 1 EGJ morphology was associated with a lower LESP. Conclusions: LES metrics on HRM do not appear to correlate with the clinical or endoscopic presentation of patients with untreated achalasia.

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Research gap in esophageal achalasia: a narrative review

Savarino,

Salvador,

Ghisa

et al. 2024

Diseases of the Esophagus

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Summary In recent years, new translational evidence, diagnostic techniques, and innovative therapies have shed new light on esophageal achalasia and revamped the attention on this relatively rare motility disorder. This narrative review aims to highlight the most recent progress and the areas where further research is needed. The four senior authors identified five topics commonly discussed in achalasia management: i.e. pathogenesis, role of functional lumen imaging probe in the diagnostic flow chart of achalasia, how to define the outcome of achalasia treatments, how to manage persistent chest pain after the treatment, and if achalasia patients’ may benefit from a regular follow-up. We searched the bibliographic databases to identify systematic reviews, meta-analyses, randomized control trials, and original research articles in English up to December 2023. We provide a summary with the most recent findings in each of the five topics and the critical points where to address future research, such as the immune-genetic patterns of achalasia that might explain the transition among the different phenotypes, the need for a validated clinical definition of treatment success, the use of neuromodulators to manage chest pain, and the need for identifying achalasia patients at risk for cancer and who may benefit of long-term follow-up. Although undoubtedly, progress has been made on the definition and management of achalasia, unmet needs remain. Debated aspects range from mechanistic insights, symptoms, objective measure relationships, and accurate clinical responses to therapeutic interventions. Translational research is eagerly awaited to answer these unresolved questions.

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Ethnic Differences in Clinical Presentations and Esophageal High-Resolution Manometry Findings in Patients with Achalasia

Cited by 3 publications

References 34 publications

Nasopharyngeal airway assistance improves esophageal intubation rates of high‐resolution esophageal manometry catheters

Nasopharyngeal airway assistance improves esophageal intubation rates of high‐resolution esophageal manometry catheters

Correlation between Lower Esophageal Sphincter Metrics on High-Resolution Manometry and the Clinical Presentation of Patients with Newly Diagnosed Achalasia

Research gap in esophageal achalasia: a narrative review

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