Akalazyanın epidemiyolojik özellikleri ve tedavi sonuçları: üçüncü basamak reflü-motilite merkezinde retrospektif bir çalışma

Abstract

Giriş ve Amaç: Akalazya, alt özofagus sfinkterinde gevşeme bozukluğu ve peristaltizmin yokluğu ile karakterize nadir bir özofagus motilite bozukluğudur. Klinik olarak ilerleyici disfaji, regürjitasyon ve kilo kaybı ile seyreder. Tanıda altın standart yüksek çözünürlüklü özofagus manometrisidir (HREM). Tedavi seçenekleri arasında pnömatik balon dilatasyonu (PBD), laparoskopik Heller miyotomi (LHM) ve peroral endoskopik miyotomi (POEM) yer alır. Tanı gecikmesi önemli bir sorundur ve hastalık progresyonunu ve tedavi sonuçlarını etkileyebilir. Bu çalışmada akalazya hastalarının demografik ve klinik özellikleri, tanı gecikmesi, alt tip dağılımı ve tedavi sonuçlarının değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: Bu retrospektif çalışmaya bir üçüncü basamak merkezde akalazya tanısı alan 111 hasta dahil edilmiştir. Hastalar Chicago sınıflaması v4.0’a göre Tip I, II veya III olarak sınıflandırılmıştır. Demografik veriler, klinik bulgular, tanı süreleri ve tedavi yanıtları analiz edilmiştir. Bulgular: Hastaların %55’i kadın, %45’i erkekti. Tip II akalazya en sık görülen alt tipti (%73,9). Medyan tanı gecikmesi 49,8 ay olup alt tipler arasında anlamlı fark saptanmadı. Tüm hastalarda katı gıda disfajisi, %95,5’inde sıvı disfajisi vardı. Başlangıç medyan Eckardt Skoru 7 idi (6–9). Tedavi sonrası skor tüm alt tiplerde anlamlı şekilde azaldı (p < 0,001). İlk tedaviler PBD (%38,7), POEM (%27,9) ve LHM (%11,7) idi. Sonuç: Tanıda anlamlı gecikmelere rağmen tüm akalazya alt tiplerinde tedavi sonrası klinik sonuçlar olumluydu. Tanı gecikmesini azaltmak ve hasta sonuçlarını iyileştirmek için erken farkındalığın artırılması, HREM kullanımının yaygınlaştırılması ve hastaların zamanında uzman merkezlere yönlendirilmesi büyük önem taşımaktadır.

Keywords

• Akalazya
• pnömatik balon dilatasyonu
• Heller miyotomi
• POEM
• yüksek çözünürlüklü manometri

Supporting Institution

Herhangi bir kurum tarafınca desteklenmemiştir

Ethical Statement

Çalışma, Kocaeli Üniversitesi Girişimsel Olmayan Klinik Araştırmalar Etik Kurulu tarafından onaylanmıştır (Karar No: GOKAEK-2025/04/09, Proje No: 2025/72). Araştırma, Helsinki Bildirgesi’nin ilkelerine uygun olarak yürütülmüştür.

Epidemiological characteristics and treatment outcomes of achalasia: a retrospective study from a tertiary reflux-motility center

Abstract

Aims: Achalasia is a rare esophageal motility disorder characterized by impaired lower esophageal sphincter relaxation and the absence of peristalsis, leading to progressive dysphagia, regurgitation, and weight loss. High-resolution esophageal manometry (HREM) is the gold standard for diagnosis. Management options include pneumatic balloon dilatation (PBD), laparoscopic Heller myotomy (LHM), and peroral endoscopic myotomy (POEM). Delayed diagnosis remains a major clinical issue and may influence disease progression and treatment outcomes. This study aimed to evaluate the demographic and clinical characteristics, diagnostic delay, subtype distribution, and treatment outcomes in patients with achalasia. Methods: This retrospective study included 111 patients diagnosed with achalasia at a tertiary care center. Patients were classified into type I, II, or III according to the Chicago classification v4.0. Demographic data, clinical presentation, diagnostic intervals, and treatment responses were analyzed. Results: The cohort consisted of 55% female and 45% male patients. Type II was the most common subtype (73.9%). The median diagnostic delay was 49.8 months, with no significant difference between subtypes. All patients reported solid food dysphagia, and 95.5% also experienced liquid dysphagia. The median baseline Eckardt score (ES) was 7 (6–9). Post-treatment ES significantly decreased across all subtypes (p<0.001). Initial treatments included PBD (38.7%), POEM (27.9%), and LHM (11.7%). Conclusion: Although diagnostic delays were substantial, all subtypes showed favorable post-treatment outcomes. Earlier disease recognition, increased HREM utilization, and timely referral to specialized centers are essential to reduce delays and improve clinical outcomes in achalasia.

Keywords

• Achalasia
• pneumatic balloon dilatation
• Heller myotomy
• POEM
• high-resolution manometry

Supporting Institution

There is no supporting/funding institution.

Ethical Statement

The study was approved by Kocaeli University, noninterventional clinical research ethical committee (Decision No: GOKAEK-2025/04/09 Project No: 2025/72). The research was conducted in accordance with the principles of the Declaration of Helsinki.

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