High-Resolution Manometry in Diagnosis and Treatment of Achalasia: Help or Hype

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• 作者：Joel E. Richter (1) (2)
  
• 关键词：Achalasia ; Subtypes of achalasia (I ; II ; III) ; Outflow obstruction ; Integrated relaxation pressure ; Timed barium esophagram ; Surgical myotomy ; Pneumatic dilation
• 刊名：Current Gastroenterology Reports
• 出版年：2014
• 出版时间：December 2014
• 年：2014
• 卷：16
• 期：12
• 全文大小：688 KB
• 参考文献：1. Boeckxstaens GE, Zaninotto G, Richter JE. Achalasia. Lancet. 2014;383:83-3. CrossRef
  2. Katz PO, Richter JE, Cowan R, Castell DO. Apparent complete lower esophageal sphincter relaxation in achalasia. Gastroenterology. 1986;90:978-3.
  3. Pandolfino JE, Fox MR, Bredenoord AJ, et al. High resolution manometry in clinical practice: utilizing pressure topography to classify oesophageal motility abnormalities. Neurogastroenterol Motil. 2009;21:796-06. / Good premier on high-resolution manometry. CrossRef
  4. Pandolfino JE, Ghosh SK, Zhang Q, et al. Quantifying EGJ morphology and relaxation with high resolution manometry: a study of 75 asymptomatic volunteers. Am J Physiol. 2007;290:A1033-0.
  5. Ghosh SK, Pandolfino JE, Rice J, et al. Impaired deglutitive EGJ relaxation in clinical esophageal manometry: a quantitative analysis of 400 patients with 75 controls. Am J Physiol. 2007;293:G878-85. / Pivotal study defining IRP-gt;-5 as the most sensitive and specific metric to define achalasia.
  6. Lin Z, Kahrilas PJ, Roman S, et al. Refining the criteria for an abnormal IRP in esophageal pressure topography based on the pattern of esophageal contractility using a classification and regression tree model. Neurogastroenterol Motil. 2012;24:e356-3. CrossRef
  7. Pandolfino JE, Kwiatek MA, Nealis T, et al. Achalasia: a new clinically relevant classification by high resolution manometry. Gastroenterology. 2008;135:1526-3. / For the first time, this large study of patients with achalasia classified three subtypes by HRM and linked them to clinical outcome. CrossRef
  8. Hernandez JC, Ratuapli SK, Burdick GE, et al. Interrater and intrarater agreement of the Chicago classification of achalasia subtypes using high resolution manometry. Am J Gastroenterol. 2012;107:207-4. / Good agreement across studies for both trainees and experts, suggesting this visual interpretation is easy to learn. CrossRef
  9. Arain MA Peters JH, Tamhankar AP, et al. Preoperative LES pressure affects outcome of laparoscopic myometry for achalasia. J Gastrointest Surg. 2004;8:328-4. CrossRef
  10. Yamashita H, Ashida K, Furkuchi T, et al. Prediction factors associated with the success of pneumatic dilation in Japanese patients with achalasia: a study of high resolution manometry. Digestion. 2013;87:23-. CrossRef
  11. Pratap N, Kalapala R, Darisetty S, et al. Achalasia cardia subtyping by high resolution manometry predicts the therapeutic outcome of pneumatic dilation. J Neurogastroenterol Motil. 2011;17:48-3. CrossRef
  12. Salvador R, Costantini M, Zaninotto G, et al. The preoperative manometric pattern predicts the outcome of surgical treatment for achalasia. J Gastroenterol Surg. 2010;14:1635-5. CrossRef
  13. Rohof WO, Salvador R, Annese V et al. Outcomes of treatment for achalasia depend on manometric subtype. Gastroenterol. 2013;144:718-5. / Prospective randomized European Achalasia Trial confirms the predictive role of the three achalasia subtypes finding type III achalasia the most difficult to treat. Some hope surgical myotomy may be helpful in type III group.
  14. Eckardt AJ, Eckardt VF. Treatment and surveillance strategies in achalasia: an update. Nat Rev Gastroenterol Hepatol. 2011;8:311-. CrossRef
  15. Vaezi ME, Baker ME, Acker E, Richter JE. Timed barium esophagram: Better predictor of longterm success after pneumatic dilation in achalasia than symptom assessment. Gut. 2002;50:765-0. CrossRef
  16. Nicodeme F, Ruigh AD, Xiao Y, et al. A comparison of symptom severity and bolus retention with Chicago classification esophageal pressure topography me
• 作者单位：Joel E. Richter (1) (2)
  
  1. Division of Digestive Diseases and Nutrition, University of South Florida Morsani College of Medicine, Tampa, FL, 33612, USA
  2. Joy McCann Culverhouse, Center for Esophageal and Swallowing Disorders, University of South Florida Morsani College of Medicine, 12901 Bruce B. Downs Blvd., MDC 72, Tampa, FL, 33612, USA
  
• ISSN：1534-312X

文摘

High-resolution manometry (HRM) with 36 pressure transducers spanning the esophagus has revolutionized the diagnosis and treatment of esophageal motility disorders, especially with respect to achalasia. The three major contributions of HRM are as follows: (a) Integrated relaxation pressure (IRP) at the esophagus gastric junction (EGJ) >15?mmHg has a sensitivity of 97?% for the diagnosis of achalasia; (b) there are three distinct subtypes of achalasia—type 1 (no distal pressurization), type II (panesophageal pressurization), and type III (spastic contractions); and (c) subtypes predict the success of treatment with type II patients doing the best and type III being the most difficult to treat. Recent studies also suggest that HRM is superior to conventional manometry for diagnosis of achalasia. Other useful observation from HRM is the recognition of EGJ outflow obstruction (type IV achalasia) with normal peristalsis which may be due to mechanical or functional impairment at the EGJ. Finally, after successful treatment of achalasia, the IRP falls to less than 15?mmHg and the achalasia pressurization pattern resolves sometimes with the return of weak peristalsis. This complements well with the information obtained by the timed barium esophagram.