Evolution of clinical and radiological features at diagnosis of achalasia during a 19-year period in central France

d’Altéroche, Louis; Oung, Chakravuth; Fourquet, Florence; Picon, Laurence; Lagasse, Jean P.; Metman, É.-H.

doi:10.1097/00042737-200102000-00006

Cited by 15 publications

(13 citation statements)

References 17 publications

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“…The prevalence of advanced ME in IdAc in our study was similar to the prevalence reported by D'Alteroche and coworkers (24%, n = 248) 15 …”

Section: Discussionsupporting

confidence: 92%

“…The esophageal diameter was the only factor influenced by the diagnostic delay in his study ( P = 0.0001), i.e. the increase in the diagnostic delay was followed by the increase in the degree of ME, result consistent with our findings 15 …”

Section: Discussionsupporting

confidence: 90%

“…The prevalence of advanced ME in IdAc in our study was similar to the prevalence reported by D'Alteroche and coworkers (24%, n = 248). 15 In patients with IdAc, we have found that the age of presentation was similar between both nonadvanced and advanced ME, although symptom duration was significantly longer in the later. In ChAc patients, we could not demonstrate differences in symptom duration between both ME groups.…”

Section: Discussionmentioning

confidence: 72%

“…Symptom duration can be an imprecise way of determining the disease duration for two reasons: first, in the initial stages of the disease, symptoms can be mild and patients cannot perceive them; second, because it was demonstrated by intra‐esophageal balloon distension test that patients with ChAc have a higher threshold for pain sensation probably related to decreased esophageal sensitivity, which can also reduce patient perception of symptoms at least in the beginning of the disease 18 . Despite this variable, the symptom duration has been used in the literature for determining disease duration 15,16 …”

Section: Discussionmentioning

confidence: 99%

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Esophageal body motility in achalasia and Chagas' disease

Abrahão

Lemme

2010

Diseases of the Esophagus

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Previous studies have correlated esophageal body motility findings in idiopathic (IdAc) achalasia and achalasia secondary to Chagas' disease (ChAc) with degree of megaesophagus. The aim of this study was to compare esophageal body manometric data in patients with IdAc and achalasia secondary to Chagas' disease and correlate it with the degree of megaesophagus and symptom duration. One hundred nontreated patients with achalasia, 79% IdAc and 21% secondary to ChAc were compared with regards to age of presentation, duration of symptoms, amplitude and duration of simultaneous contractions, frequency of failed contractions, and degree of megaesophagus. Seventy-one percent of patients were classified as nonadvanced megaesophagus (60 [76%] with IdAc and 11 [52%] with ChAc) and 29% as advanced megaesophagus (19 [24%] with IdAc and 10 [48%] with ChAc, P= 0.04). In IdAc but not in ChAc, the symptom duration was significantly longer in advanced megaesophagus (A) compared with nonadvanced megaesophagus (NA) (34.8 ± 6.3 months vs. 95.4 ± 22.2 months, P= 0.001). There was no difference in amplitude and duration of simultaneous contractions in both achalasia groups (P > 0.05). Duration of contractions were longer in IdAc compared with ChAc in (NA) (P < 0.05), but not in (A). In IdAc but not in ChAc the amplitude of simultaneous contractions decreased with increased esophageal dilatation (P < 0.05). In ChAc but not in IdAC, the duration of contractions increased with esophageal dilatation (P < 0.05). Failed contractions were more frequent in ChAc group (28.6%) than in IdAc (10% -P= 0.03). Patients with ChAc have a higher prevalence of advanced megaesophagus compared with IdAc at diagnosis. In IdAc there was a strong correlation between advanced megaesophagus and longer symptom duration, suggesting disease progression over time, not observed in ChAc in which a more extensive denervation occurs earlier in the disease process.

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“…The prevalence of advanced ME in IdAc in our study was similar to the prevalence reported by D'Alteroche and coworkers (24%, n = 248) 15 …”

Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 72%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Esophageal body motility in achalasia and Chagas' disease

Abrahão

Lemme

2010

Diseases of the Esophagus

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“…d'Alteroche et al estimated the evolution of clinical and radiologic features of a large population of achalasic patients. 10 Dysphagia, chest pain, and heartburn were more frequent in young patients. Women had 1.7 times the risk of men for suffering of chest pain and 2.2 times the risk for heartburn.…”

Section: Introductionmentioning

confidence: 97%

Surgical treatment for achalasia: when should it be performed, and for which patients?

Kashiwagi

Omura

2011

Gen Thorac Cardiovasc Surg

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Achalasia is a rare motor disorder of the esophagus, characterized by the absence of peristalsis and impaired swallow-induced relaxation. In the past decade, evidence has been accumulated suggesting that achalasia may be an immune-mediated inflammatory disorder. With the advent of minimally invasive surgery, laparoscopic Heller myotomy (LHM) has slowly shifted the treatment of achalasia toward the greater use of surgical therapy. The goal of both surgical and nonsurgical treatment is to eliminate the outflow obstruction afforded by a nonrelaxing sphincter, relieving dysphagia and maintaining a barrier against gastroesophageal reflux (GER). Endoscopic botulinum toxin injection (EBTI) is safe, easy to perform, inexpensive, and effective in aged patients, and it is especially effective when the lower esophageal pressure is hypertonic. This therapeutic option is reserved for patients too ill to undergo any surgical procedure. Pneumatic dilation (PD) has been shown to be an effective and inexpensive treatment with few adverse effects. The long-term success rate of PD seems to drop progressively over time. Heller myotomy (HM) has shown the best clinical efficacy in achalasia as a first-line treatment. Multiple endoscopic treatments are associated with poorer outcomes after HM. EBTI also makes LHM more difficult and results in a worse surgical outcome. The inferior symptomatic outcomes after thoracoscopic HM may be caused by the difficulty in extending an adequate myotomy onto the stomach from the chest and the inability to create a fundoplication. LHM with Dor's fundoplication (LHM + Dor) is effective and is safer procedure for avoiding GER, dysphagia, mucosal perforation, and a pseudodiverticulum. LHM + Dor is also effective in the presence of sigmoid achalasia, but the clinical result is not as good as nonsigmoid achalasia. A few patients need esophagectomy for surgical failure of HM. However, considering the risk of esophagectomy, LHM + Dor is the first treatment option for patients with achalasia regardless of the degree of esophageal dilatation. This procedure is therefore considered to be an effective and safe treatment for patients of any age or with any condition.

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La manométrie œsophagienne est-elle incontournable dans la prise en charge de l’achalasie ?

Amrani¹,

Serraj²,

Kanouni³

et al. 2003

Acta Endosc

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Evolution of clinical and radiological features at diagnosis of achalasia during a 19-year period in central France

Abstract: Despite a smaller oesophageal diameter at the time of diagnosis, during the period 1994-1998, diagnostic delay was not reduced. No clinical features associated with late diagnoses could be identified.

Cited by 15 publications

References 17 publications

Esophageal body motility in achalasia and Chagas' disease

Esophageal body motility in achalasia and Chagas' disease

Surgical treatment for achalasia: when should it be performed, and for which patients?

La manométrie œsophagienne est-elle incontournable dans la prise en charge de l’achalasie ?

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