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Erschienen in: Journal of Gastroenterology 2/2016

01.02.2016 | Original Article—Alimentary Tract

Achalasia symptom response after Heller myotomy segregated by high-resolution manometry subtypes

verfasst von: Amit Patel, Ami Patel, Faiz A. Mirza, Samad Soudagar, Gregory S. Sayuk, C. Prakash Gyawali

Erschienen in: Journal of Gastroenterology | Ausgabe 2/2016

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Abstract

Background

Achalasia is classified into three HRM subtypes that predict outcomes from diverse management strategies. We assessed if symptomatic response varied when a single management strategy—Heller myotomy (HM)—is employed.

Methods

Treatment-naive subjects with achalasia referred for HM were followed in this observational cohort study. Chicago criteria designated achalasia subtypes (subtype I: no esophageal pressurization; subtype II: panesophageal pressurization in ≥20 % swallows; subtype III: premature contractions in ≥20 % swallows). Symptom questionnaires assessed symptom burden before and after HM on five-point Likert scales (0 = no symptoms, 4 = severe symptoms) and on 10-cm visual analog scales (global symptom severity, GSS); satisfaction with HM was recorded similarly. Data were analyzed to determine predictors of GSS change across subtypes.

Results

Sixty achalasia subjects (56.1 ± 2.4 years, 55 % female) fulfilled inclusion criteria, 15 % with subtype I, 58 % with subtype II, and 27 % with subtype III achalasia. Baseline symptoms included dysphagia (solids: 85 %, liquids: 73 %), regurgitation (84 %), and chest pain (35 %); mean GSS was 7.1 ± 0.3. Upon follow-up 2.1 ± 0.2 years after HM, GSS declined to 1.9 ± 0.4 (p < 0.001), with surgical satisfaction score of 8.7 ± 0.3 out of 10; these were similar across achalasia subtypes. On univariate analysis, female gender, Eckardt score, severity of transit symptoms, and maximal IRP predicted linear GSS improvement; female gender (p = 0.003) and dysphagia for liquids (p = 0.043) remained predictive on multivariate analysis.

Conclusions

When a uniform surgical approach is utilized, symptomatic outcome and satisfaction with therapy are similar across achalasia subtypes. Female gender and severity of dysphagia for solids may predict better HM outcome.
Literatur
1.
Zurück zum Zitat Vaezi MF, Pandolfino JE, Vela MF. ACG clinical guideline: diagnosis and management of achalasia. Am J Gastroenterol. 2013;108:1238–49 (quiz 1250).CrossRefPubMed Vaezi MF, Pandolfino JE, Vela MF. ACG clinical guideline: diagnosis and management of achalasia. Am J Gastroenterol. 2013;108:1238–49 (quiz 1250).CrossRefPubMed
2.
Zurück zum Zitat Hirano I, Tatum RP, Shi G, et al. Manometric heterogeneity in patients with idiopathic achalasia. Gastroenterology. 2001;120:789–98.CrossRefPubMed Hirano I, Tatum RP, Shi G, et al. Manometric heterogeneity in patients with idiopathic achalasia. Gastroenterology. 2001;120:789–98.CrossRefPubMed
3.
Zurück zum Zitat Todorczuk JR, Aliperti G, Staiano A, et al. Reevaluation of manometric criteria for vigorous achalasia. Is this a distinct clinical disorder? Dig Dis Sci. 1991;36:274–8.CrossRefPubMed Todorczuk JR, Aliperti G, Staiano A, et al. Reevaluation of manometric criteria for vigorous achalasia. Is this a distinct clinical disorder? Dig Dis Sci. 1991;36:274–8.CrossRefPubMed
4.
Zurück zum Zitat Clouse RE, Staiano A, Alrakawi A, et al. Application of topographical methods to clinical esophageal manometry. Am J Gastroenterol. 2000;95:2720–30.CrossRefPubMed Clouse RE, Staiano A, Alrakawi A, et al. Application of topographical methods to clinical esophageal manometry. Am J Gastroenterol. 2000;95:2720–30.CrossRefPubMed
5.
Zurück zum Zitat Pandolfino JE, Kwiatek MA, Nealis T, et al. Achalasia: a new clinically relevant classification by high-resolution manometry. Gastroenterology. 2008;135:1526–33.PubMedCentralCrossRefPubMed Pandolfino JE, Kwiatek MA, Nealis T, et al. Achalasia: a new clinically relevant classification by high-resolution manometry. Gastroenterology. 2008;135:1526–33.PubMedCentralCrossRefPubMed
6.
Zurück zum Zitat Rohof WO, Salvador R, Annese V, et al. Outcomes of treatment for achalasia depend on manometric subtype. Gastroenterology. 2013;144:718–25 (quiz e13–4).CrossRefPubMed Rohof WO, Salvador R, Annese V, et al. Outcomes of treatment for achalasia depend on manometric subtype. Gastroenterology. 2013;144:718–25 (quiz e13–4).CrossRefPubMed
7.
Zurück zum Zitat Boeckxstaens GE, Annese V, desVarannes SB, et al. Pneumatic dilation versus laparoscopic Heller’s myotomy for idiopathic achalasia. N Engl J Med. 2011;364:1807–16.CrossRefPubMed Boeckxstaens GE, Annese V, desVarannes SB, et al. Pneumatic dilation versus laparoscopic Heller’s myotomy for idiopathic achalasia. N Engl J Med. 2011;364:1807–16.CrossRefPubMed
8.
Zurück zum Zitat Greene CL, Chang EJ, Oh DS, et al. High resolution manometry sub-classification of Achalasia: does it really matter? Does Achalasia sub-classification matter? Surg Endosc. 2015;29:1363–7.CrossRefPubMed Greene CL, Chang EJ, Oh DS, et al. High resolution manometry sub-classification of Achalasia: does it really matter? Does Achalasia sub-classification matter? Surg Endosc. 2015;29:1363–7.CrossRefPubMed
9.
Zurück zum Zitat Bredenoord AJ, Fox M, Kahrilas PJ, et al. Chicago classification criteria of esophageal motility disorders defined in high resolution esophageal pressure topography. Neurogastroenterol Motil. 2012;24(Suppl 1):57–65.PubMedCentralCrossRefPubMed Bredenoord AJ, Fox M, Kahrilas PJ, et al. Chicago classification criteria of esophageal motility disorders defined in high resolution esophageal pressure topography. Neurogastroenterol Motil. 2012;24(Suppl 1):57–65.PubMedCentralCrossRefPubMed
10.
Zurück zum Zitat Patel A, Sayuk GS, Gyawali CP. Acid-based parameters on pH-impedance testing predict symptom improvement with medical management better than impedance parameters. Am J Gastroenterol. 2014;109:836–44.PubMedCentralCrossRefPubMed Patel A, Sayuk GS, Gyawali CP. Acid-based parameters on pH-impedance testing predict symptom improvement with medical management better than impedance parameters. Am J Gastroenterol. 2014;109:836–44.PubMedCentralCrossRefPubMed
11.
Zurück zum Zitat Reidel WL, Clouse RE. Variations in clinical presentation of patients with esophageal contraction abnormalities. Dig Dis Sci. 1985;30:1065–71.CrossRefPubMed Reidel WL, Clouse RE. Variations in clinical presentation of patients with esophageal contraction abnormalities. Dig Dis Sci. 1985;30:1065–71.CrossRefPubMed
12.
Zurück zum Zitat Kushnir VM, Gyawali CP. High resolution manometry patterns distinguish acid sensitivity in non-cardiac chest pain. Neurogastroenterol Motil. 2011;23:1066–72.PubMedCentralCrossRefPubMed Kushnir VM, Gyawali CP. High resolution manometry patterns distinguish acid sensitivity in non-cardiac chest pain. Neurogastroenterol Motil. 2011;23:1066–72.PubMedCentralCrossRefPubMed
13.
Zurück zum Zitat Patel A, Sayuk GS, Gyawali CP. Parameters on esophageal pH impedance monitoring that predict outcomes of patients with gastroesophageal reflux disease. Clin Gastroenterol Hepatol. 2015;13:884–91.CrossRefPubMed Patel A, Sayuk GS, Gyawali CP. Parameters on esophageal pH impedance monitoring that predict outcomes of patients with gastroesophageal reflux disease. Clin Gastroenterol Hepatol. 2015;13:884–91.CrossRefPubMed
14.
Zurück zum Zitat Porter RF, Gyawali CP. Botulinum toxin injection in dysphagia syndromes with preserved esophageal peristalsis and incomplete lower esophageal sphincter relaxation. Neurogastroenterol Motil. 2011;23:139–44 (e27–8).CrossRefPubMed Porter RF, Gyawali CP. Botulinum toxin injection in dysphagia syndromes with preserved esophageal peristalsis and incomplete lower esophageal sphincter relaxation. Neurogastroenterol Motil. 2011;23:139–44 (e27–8).CrossRefPubMed
15.
Zurück zum Zitat Gyawali CP, Kushnir VM. High-resolution manometric characteristics help differentiate types of distal esophageal obstruction in patients with peristalsis. Neurogastroenterol Motil. 2011;23:502–e197.CrossRefPubMed Gyawali CP, Kushnir VM. High-resolution manometric characteristics help differentiate types of distal esophageal obstruction in patients with peristalsis. Neurogastroenterol Motil. 2011;23:502–e197.CrossRefPubMed
16.
Zurück zum Zitat Kushnir V, Sayuk GS, Gyawali CP. Multiple rapid swallow responses segregate achalasia subtypes on high-resolution manometry. Neurogastroenterol Motil. 2012;24:1069–e561.PubMedCentralCrossRefPubMed Kushnir V, Sayuk GS, Gyawali CP. Multiple rapid swallow responses segregate achalasia subtypes on high-resolution manometry. Neurogastroenterol Motil. 2012;24:1069–e561.PubMedCentralCrossRefPubMed
17.
Zurück zum Zitat Kushnir VM, Sayuk GS, Gyawali CP. Abnormal GERD parameters on ambulatory pH monitoring predict therapeutic success in noncardiac chest pain. Am J Gastroenterol. 2010;105:1032–8.CrossRefPubMed Kushnir VM, Sayuk GS, Gyawali CP. Abnormal GERD parameters on ambulatory pH monitoring predict therapeutic success in noncardiac chest pain. Am J Gastroenterol. 2010;105:1032–8.CrossRefPubMed
18.
Zurück zum Zitat Eckardt AJ, Eckardt VF. Treatment and surveillance strategies in achalasia: an update. Nat Rev Gastroenterol Hepatol. 2011;8:311–9.CrossRefPubMed Eckardt AJ, Eckardt VF. Treatment and surveillance strategies in achalasia: an update. Nat Rev Gastroenterol Hepatol. 2011;8:311–9.CrossRefPubMed
19.
Zurück zum Zitat Pratap N, Kalapala R, Darisetty S, et al. Achalasia cardia subtyping by high-resolution manometry predicts the therapeutic outcome of pneumatic balloon dilatation. J Neurogastroenterol Motil. 2011;17:48–53.PubMedCentralCrossRefPubMed Pratap N, Kalapala R, Darisetty S, et al. Achalasia cardia subtyping by high-resolution manometry predicts the therapeutic outcome of pneumatic balloon dilatation. J Neurogastroenterol Motil. 2011;17:48–53.PubMedCentralCrossRefPubMed
20.
Zurück zum Zitat Roman S, Kahrilas PJ, Mion F, et al. Partial recovery of peristalsis after myotomy for achalasia: more the rule than the exception. JAMA Surg. 2013;148:157–64.PubMedCentralCrossRefPubMed Roman S, Kahrilas PJ, Mion F, et al. Partial recovery of peristalsis after myotomy for achalasia: more the rule than the exception. JAMA Surg. 2013;148:157–64.PubMedCentralCrossRefPubMed
21.
Zurück zum Zitat Hong SJ, Bhargava V, Jiang Y, et al. A unique esophageal motor pattern that involves longitudinal muscles is responsible for emptying in achalasia esophagus. Gastroenterology. 2010;139:102–11.PubMedCentralCrossRefPubMed Hong SJ, Bhargava V, Jiang Y, et al. A unique esophageal motor pattern that involves longitudinal muscles is responsible for emptying in achalasia esophagus. Gastroenterology. 2010;139:102–11.PubMedCentralCrossRefPubMed
22.
Zurück zum Zitat Roman S, Zerbib F, Queneherve L, et al. The Chicago classification for achalasia in a French multicentric cohort. Dig Liver Dis. 2012;44:976–80.CrossRefPubMed Roman S, Zerbib F, Queneherve L, et al. The Chicago classification for achalasia in a French multicentric cohort. Dig Liver Dis. 2012;44:976–80.CrossRefPubMed
23.
Zurück zum Zitat Kahrilas PJ, Boeckxstaens G. The spectrum of achalasia: lessons from studies of pathophysiology and high-resolution manometry. Gastroenterology. 2013;145:954–65.CrossRefPubMed Kahrilas PJ, Boeckxstaens G. The spectrum of achalasia: lessons from studies of pathophysiology and high-resolution manometry. Gastroenterology. 2013;145:954–65.CrossRefPubMed
24.
Zurück zum Zitat Kahrilas PJ, Bredenoord AJ, Fox M, et al. The Chicago classification of esophageal motility disorders, v3.0. Neurogastroenterol Motil. 2015;27:160–74.CrossRefPubMed Kahrilas PJ, Bredenoord AJ, Fox M, et al. The Chicago classification of esophageal motility disorders, v3.0. Neurogastroenterol Motil. 2015;27:160–74.CrossRefPubMed
Metadaten
Titel
Achalasia symptom response after Heller myotomy segregated by high-resolution manometry subtypes
verfasst von
Amit Patel
Ami Patel
Faiz A. Mirza
Samad Soudagar
Gregory S. Sayuk
C. Prakash Gyawali
Publikationsdatum
01.02.2016
Verlag
Springer Japan
Erschienen in
Journal of Gastroenterology / Ausgabe 2/2016
Print ISSN: 0944-1174
Elektronische ISSN: 1435-5922
DOI
https://doi.org/10.1007/s00535-015-1088-6

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