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Akalazya tanısında yüksek çözünürlüklü manometri: 3. basamak referans merkez deneyimi

Year 2019, Volume: 27 Issue: 3, 74 - 79, 25.12.2019
https://doi.org/10.17940/endoskopi.679107

Abstract

Giriş ve Amaç: Özofagusun etiyolojisi bilinmeyen primer motor bozukluğu olan akalazya, kesin tanısı motilite çalışmaları yapılarak konulan bir hastalıktır. Özofagogastrik bileşkede bulunan, maligniteye ya da geçirilmiş cerrahiye sekonder gelişen obstrüksiyon, hem klinik olarak, hem de manometrik ölçüm sonuçlarıyla akalazyayı taklit edebilir. Çok sık rastlanan bir durum olmayan akalazyanın, ülkemizdeki epidemiyolojik özelliklerine ilişkin veriler son derece sınırlıdır. Güncel çalışmada, kliniğimizde takip edilen akalazyalı hastaların, epidemiyolojik özelliklerinin ve manometrik bulgularının incelenmesi amaçlanmıştır.
Gereç ve Yöntem: Ekim 2017-Kasım 2019 tarihleri arasında, üniversitemiz gastroenteroloji bilim dalı motilite polikliniğinde tetkik edilen ve yüksek çözünürlüklü manometri sonuçlarına göre akalazya tanısı koyulan hastaların bilgi kartları, retrospektif olarak incelendi.
Bulgular: Akalazya ön tanısıyla yüksek çözünürlüklü manometri yapılan 8 hastanın pseudoakalazya, 2 hastanın sekonder akalazya olduğu görüldü. Akalazya tanısı konulan 77 hastanın (43 erkek), yaş ortalaması 49.9917.68 (23-76) idi. Hastaların dörtte birinin 36 yaşından küçük, dörtte birinin 63.5 yaşından büyük olduğu görüldü. Hafifçe erkek baskın gibi görünen hasta grubunda, semptom başlangıcından tanı konuluncaya kadar geçen sürenin ortalama 4.434.05 (1-20) yıl olduğu görüldü. Chicago Class 3.0 kriterlerine göre hastaların 35 tanesi (%45.5) Tip 1; 39 tanesi (%50.6) Tip 2; üç tanesi (%3.9) ise Tip 3 akalazya tanısı almıştı. Özofagogastrik bileşke gevşemesinin değerlendirilmesi için kullanılan entegre gevşeme basıncı ortalama 22.8111.44 mm Hg ve alt özofagus istirahat basıncı ise ortalama 31.9618.74 mm Hg idi. Tip 2 hastalarda entegre gevşeme basıncı ve ortalama alt özofagus istirahat basıncı Tip 1 hastalara göre, istatistiksel açıdan anlamlı olarak daha yüksek idi (sırasıyla, p<0.001 ve p<0.001).
Sonuç: Akalazya hastalığının tanısı, günümüz teknolojisi ve bilgi birikimiyle sorun olmaktan çıkmış gibi gözükmektedir. Tanı ve tedavisi noktasında en büyük sorun, hastaların motilite çalışmalarına erişimine engel olan çeşitli bariyerlerdir. Tanı öncesi semptom süresinin uzun olmasında, özofagus motilite testlerinin gecikmeli olarak yapılması rol oynuyor olabilir. Bunu önlemek adına, disfajisi olan hastalar, özofagogastroskopik incelemeleri normal bulunsa bile, muhakkak motilite testi yapılması için yönlendirilmelidir.

References

  • 1. Vaezi MF, Pandolfino JE,Vela MF. ACG clinical guideline: diagnosis and management of achalasia. Am J Gastroenterol 2013;108:1238-49, quiz 1250.
  • 2.Francis DL, Katzk DA. Achalasia: update on the disease and its treatment. Gastroenterology 2010;139:369-74.
  • 3. Tucker HJ, SnapeWJ Jr, Cohen S. Achalasia secondary to carcinoma: manometric and clinical features. Ann Intern Med 1978;89:315-8.
  • 4. Rozman RW Jr, Achkar E. Features distinguishing secondary achalasia from primary achalasia. Am J Gastroenterol 1990;85:1327-30.
  • 5. Pandolfino JE, Fox MR, Bredenoord AJ, Kahrilas PJ. High resolution manometry in clinical practice: utilizing pressure topography to classify oesophageal motility abnormalities. Neurogastroenterol Motil 2009;21:796-806.
  • 6. Kahrilas PJ, Bredenoord AJ, Fox M, et al; International High Resolution Manometry Working Group. The Chicago Classification of esophageal motility disorders, v3.0. Neurogastroenterol Motil 2015;27:160-74.
  • 7. Zaninotto G, Bennett C, Boeckxstaens G, et al. The 2018 ISDE achalasia guidelines. Dis Esophagus 2018;31:1-29.
  • 8. Roman S, Huot L, Zerbib F, et al. High-resolution manometry improves the diagnosis of esophageal motility disorders in patients with dysphagia: a randomized multicenter study. Am J Gastroenterol 2016;111:372-80.
  • 9. Richter JE. High-resolution manometry in diagnosis and treatment of achalasia: help or hype. Curr Gastroenterol Rep 2014;16:420.
  • 10. Carlson DA, LinZ, Kahrilas PJ, et al. The functional lumen imaging probe detects esophageal contractility not observed with manometry in patients with achalasia. Gastroenterology 2015;149:1742-51.
  • 11. Ghosh SK, Pandolfino JE, Rice J, et al. Impaired deglutitive EGJ relaxation in clinical esophageal manometry: a quantitative analysis of 400 patients and 75 controls. Am J Physiol Gastrointest Liver Physiol 2007;293:878-85.
  • 12. Mayberry JF, Atkinson M. Studies of incidence and prevalence of achalasia in the Nottingham area. Q J Med 1985;56:451-6.
  • 13. Sonnenberg A, Massey BT, McCarty DJ, Jacobsen SJ. Epidemiology of hospitalization for achalasia in the United States. Dig Dis Sci 1993;38:233-44.
  • 14. Farrukh A, DeCaestecker J, Mayberry JF. An epidemiological study of achalasia among the South Asian population of Leicester, 1986-2005. Dysphagia 2008;23:161-4.
  • 15. Arber N, Grossman A, Lurie B, et al. Epidemiology of achalasia in central Israel. Rarity of esophageal cancer. Dig Dis Sci 1993;38:1920-5.
  • 16.Mayberry JF, Atkinson M. Variations in the prevalence of achalasia in Great Britain and Ireland: an epidemiological study based on hospital admission. Q J Med 1987;62:67-74.
  • 17.Mayberry JF, Atkinson M. Incidence of achalasia in New Zealand, 1980-84: an epidemiologic study based on hospital discharges. J Gastroenterol Hepatol 1988;3:247-52.
  • 18. Sonnenberg A. Hospitalization for achalasia in the United States 1997-2006. Dig Dis Sci 2009;54:1680-5.
  • 19. Earlam RJ, Ellis FH Jr, Nobrega FT. Achalasia of the esophagus in a small urban community. Mayo Clin Proc 1969;44:478-83.
  • 20. Ho KY, Tay HH, Kang JY. A prospective study of the clinical features, manometric findings, incidence and prevalence of achalasia in Singapore. J Gastroenterol Hepatol 1999;14:791-5.
  • 21. Howard PJ, Maher L, Pryde A, Cameron EW, Heading RC. Five year prospective study of the incidence, clinical features, and diagnosis of achalasia in Edinburgh. Gut 1992;33:1011-5.
  • 22. Mayberry JF, Rhodes J. Achalasia in the city of Cardiff from 1926 to 1977. Digestion 1980;20:248-52.
  • 23. Birgisson S, Richter JE. Achalasia: what’s new in diagnosis and treatment? Dig Dis 1997;15(Suppl 1):1-27.

High resolution manometry for diagnosis of achalasia: Tertiary reference center experience

Year 2019, Volume: 27 Issue: 3, 74 - 79, 25.12.2019
https://doi.org/10.17940/endoskopi.679107

Abstract

Background and Aims: Achalasia, which is a primary motor disorder with unknown etiology, is diagnosed using motility studies. Obstruction of the esophagogastric junction secondary to malignancy or previous surgery may mimic achalasia, both clinically and manometrically. Data related to the epidemiological characteristics of achalasia are minimal. This study investigated the epidemiological features and manometric findings of patients with achalasia who were followed up in our clinic.
Material and Methods: Data of patients diagnosed with achalasia by using high resolution manometry between October 2017 and November 2019 were evaluated retrospectively.
Results: Eight patients had pseudoachalasia, and two patients had secondary achalasia. The mean age of the 77 patients (43 male) diagnosed as true achalasia was 49.9917.68 years (23–76 years). One-fourth of the patients were younger than 36 years, and one-fourth were older than 63.5 years. The mean time from onset of symptom to diagnosis was 4.434.05 years (1–20 years) in the slightly male predominant patient group. According to Chicago Class 3.0 criteria, patients were diagnosed as Type 1, 2, and 3 achalasia in 35 (45.5%), 39 (50.6%), and 3 (3.9%) study patients, respectively. The mean relaxation pressure used for the evaluation of esophagogastric junction relaxation was 22.8111.44 mmHg, and the mean lower esophageal resting pressure was 31.9618.74 mmHg. The mean relaxation pressure and mean lower esophageal resting pressure were significantly higher in Type 2 patients than Type 1 patients (p < 0.001 and p < 0.001, respectively).
Discussion: The current technology facilitates the easy diagnosis of achalasia. However, the major problem in diagnosis and treatment is the various barriers that prevent patients from accessing motility studies. Delayed esophageal motility tests may cause prolonged pre-diagnosis symptoms. Patients with dysphagia should be referred for an esophageal motility test, even if their esophagogastroscopic examination is normal.

References

  • 1. Vaezi MF, Pandolfino JE,Vela MF. ACG clinical guideline: diagnosis and management of achalasia. Am J Gastroenterol 2013;108:1238-49, quiz 1250.
  • 2.Francis DL, Katzk DA. Achalasia: update on the disease and its treatment. Gastroenterology 2010;139:369-74.
  • 3. Tucker HJ, SnapeWJ Jr, Cohen S. Achalasia secondary to carcinoma: manometric and clinical features. Ann Intern Med 1978;89:315-8.
  • 4. Rozman RW Jr, Achkar E. Features distinguishing secondary achalasia from primary achalasia. Am J Gastroenterol 1990;85:1327-30.
  • 5. Pandolfino JE, Fox MR, Bredenoord AJ, Kahrilas PJ. High resolution manometry in clinical practice: utilizing pressure topography to classify oesophageal motility abnormalities. Neurogastroenterol Motil 2009;21:796-806.
  • 6. Kahrilas PJ, Bredenoord AJ, Fox M, et al; International High Resolution Manometry Working Group. The Chicago Classification of esophageal motility disorders, v3.0. Neurogastroenterol Motil 2015;27:160-74.
  • 7. Zaninotto G, Bennett C, Boeckxstaens G, et al. The 2018 ISDE achalasia guidelines. Dis Esophagus 2018;31:1-29.
  • 8. Roman S, Huot L, Zerbib F, et al. High-resolution manometry improves the diagnosis of esophageal motility disorders in patients with dysphagia: a randomized multicenter study. Am J Gastroenterol 2016;111:372-80.
  • 9. Richter JE. High-resolution manometry in diagnosis and treatment of achalasia: help or hype. Curr Gastroenterol Rep 2014;16:420.
  • 10. Carlson DA, LinZ, Kahrilas PJ, et al. The functional lumen imaging probe detects esophageal contractility not observed with manometry in patients with achalasia. Gastroenterology 2015;149:1742-51.
  • 11. Ghosh SK, Pandolfino JE, Rice J, et al. Impaired deglutitive EGJ relaxation in clinical esophageal manometry: a quantitative analysis of 400 patients and 75 controls. Am J Physiol Gastrointest Liver Physiol 2007;293:878-85.
  • 12. Mayberry JF, Atkinson M. Studies of incidence and prevalence of achalasia in the Nottingham area. Q J Med 1985;56:451-6.
  • 13. Sonnenberg A, Massey BT, McCarty DJ, Jacobsen SJ. Epidemiology of hospitalization for achalasia in the United States. Dig Dis Sci 1993;38:233-44.
  • 14. Farrukh A, DeCaestecker J, Mayberry JF. An epidemiological study of achalasia among the South Asian population of Leicester, 1986-2005. Dysphagia 2008;23:161-4.
  • 15. Arber N, Grossman A, Lurie B, et al. Epidemiology of achalasia in central Israel. Rarity of esophageal cancer. Dig Dis Sci 1993;38:1920-5.
  • 16.Mayberry JF, Atkinson M. Variations in the prevalence of achalasia in Great Britain and Ireland: an epidemiological study based on hospital admission. Q J Med 1987;62:67-74.
  • 17.Mayberry JF, Atkinson M. Incidence of achalasia in New Zealand, 1980-84: an epidemiologic study based on hospital discharges. J Gastroenterol Hepatol 1988;3:247-52.
  • 18. Sonnenberg A. Hospitalization for achalasia in the United States 1997-2006. Dig Dis Sci 2009;54:1680-5.
  • 19. Earlam RJ, Ellis FH Jr, Nobrega FT. Achalasia of the esophagus in a small urban community. Mayo Clin Proc 1969;44:478-83.
  • 20. Ho KY, Tay HH, Kang JY. A prospective study of the clinical features, manometric findings, incidence and prevalence of achalasia in Singapore. J Gastroenterol Hepatol 1999;14:791-5.
  • 21. Howard PJ, Maher L, Pryde A, Cameron EW, Heading RC. Five year prospective study of the incidence, clinical features, and diagnosis of achalasia in Edinburgh. Gut 1992;33:1011-5.
  • 22. Mayberry JF, Rhodes J. Achalasia in the city of Cardiff from 1926 to 1977. Digestion 1980;20:248-52.
  • 23. Birgisson S, Richter JE. Achalasia: what’s new in diagnosis and treatment? Dig Dis 1997;15(Suppl 1):1-27.
There are 23 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Articles
Authors

Göktuğ Şirin 0000-0002-6945-3193

Buğra Tolga Konduk 0000-0002-9138-9984

Seher Şirin 0000-0002-2982-9379

Altay Çelebi 0000-0003-2864-7124

Publication Date December 25, 2019
Published in Issue Year 2019 Volume: 27 Issue: 3

Cite

APA Şirin, G., Konduk, B. T., Şirin, S., Çelebi, A. (2019). Akalazya tanısında yüksek çözünürlüklü manometri: 3. basamak referans merkez deneyimi. Endoskopi Gastrointestinal, 27(3), 74-79. https://doi.org/10.17940/endoskopi.679107
AMA Şirin G, Konduk BT, Şirin S, Çelebi A. Akalazya tanısında yüksek çözünürlüklü manometri: 3. basamak referans merkez deneyimi. Endoskopi Gastrointestinal. December 2019;27(3):74-79. doi:10.17940/endoskopi.679107
Chicago Şirin, Göktuğ, Buğra Tolga Konduk, Seher Şirin, and Altay Çelebi. “Akalazya tanısında yüksek çözünürlüklü Manometri: 3. Basamak Referans Merkez Deneyimi”. Endoskopi Gastrointestinal 27, no. 3 (December 2019): 74-79. https://doi.org/10.17940/endoskopi.679107.
EndNote Şirin G, Konduk BT, Şirin S, Çelebi A (December 1, 2019) Akalazya tanısında yüksek çözünürlüklü manometri: 3. basamak referans merkez deneyimi. Endoskopi Gastrointestinal 27 3 74–79.
IEEE G. Şirin, B. T. Konduk, S. Şirin, and A. Çelebi, “Akalazya tanısında yüksek çözünürlüklü manometri: 3. basamak referans merkez deneyimi”, Endoskopi Gastrointestinal, vol. 27, no. 3, pp. 74–79, 2019, doi: 10.17940/endoskopi.679107.
ISNAD Şirin, Göktuğ et al. “Akalazya tanısında yüksek çözünürlüklü Manometri: 3. Basamak Referans Merkez Deneyimi”. Endoskopi Gastrointestinal 27/3 (December 2019), 74-79. https://doi.org/10.17940/endoskopi.679107.
JAMA Şirin G, Konduk BT, Şirin S, Çelebi A. Akalazya tanısında yüksek çözünürlüklü manometri: 3. basamak referans merkez deneyimi. Endoskopi Gastrointestinal. 2019;27:74–79.
MLA Şirin, Göktuğ et al. “Akalazya tanısında yüksek çözünürlüklü Manometri: 3. Basamak Referans Merkez Deneyimi”. Endoskopi Gastrointestinal, vol. 27, no. 3, 2019, pp. 74-79, doi:10.17940/endoskopi.679107.
Vancouver Şirin G, Konduk BT, Şirin S, Çelebi A. Akalazya tanısında yüksek çözünürlüklü manometri: 3. basamak referans merkez deneyimi. Endoskopi Gastrointestinal. 2019;27(3):74-9.