Correlation between clinical severity score and the lower esophageal sphincter relaxation pressure in idiopathic achalasia

Yaghoobi, Mohammad; Mikaeli, Javad; Montazeri, Ghodratollah; Nouri, Negin; Sohrabi, Masoud Reza; Malekzadeh, Reza

doi:10.1016/s0002-9270(02)05934-8

Cited by 18 publications

(10 citation statements)

References 21 publications

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“…8,10 TBE, HRM, and symptoms Review of prior literature regarding correlation of symptoms with TBE or HRM findings shows inconsistent results. 3,8,9,[13][14][15][16][17][18][19] Andersson and colleagues reported an inverse correlation between TBE width and postprandial chest pain (r = −0.44). 13 In a study by Yaghoobi and colleagues, active and passive regurgitation showed significant correlation with LES pressure.…”

Section: Principal Findingsmentioning

confidence: 99%

Timed barium esophagram in achalasia types

Zanoni¹,

Rice²,

López³

et al. 2014

Dis Esophagus

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Relationships of timed barium esophagram (TBE) findings to achalasia types defined by high-resolution manometry (HRM) have not been elucidated. Therefore, we correlated preoperative TBE and HRM measurements in achalasia types and related these to patient symptoms and prior treatments. From 2006 to 2013, 248 achalasia patients underwent TBE and HRM before Heller myotomy. TBE height and width were recorded at 1 and 5 minutes; HRM measured lower esophageal sphincter mean basal pressure, integrated relaxation pressure (IRP), and mean esophageal body contraction amplitude. Achalasia was classified into types I (25%), II (65%), and III (9.7%). TBE height at 5 minutes was higher for I (median 8 cm; interquartile range 6-12) and II (8 cm; 8-11) than for III (1 cm; 0-7). TBE width at 5 minutes was widest (3 cm; 2-4), narrower in II (2 cm; 2-3), and narrowest in I (1 cm; 0-2), P < 0.001. Volume remaining at 1 and 5 minutes was lower in III (1 m(2) ; 0-16) than I (42 m(2) ; 17-106) and II (39 m(2) ; 15-60), highlighting poorer emptying of I and II. Increasing TBE width correlated with deteriorating morphology and function from III to II to I. Symptoms poorly correlated with TBE and HRM. Prior treatment was associated with less regurgitation, faster emptying, and lower IRP. Although TBE and HRM are correlated in many respects, the wide range of their measurements observed in this study reveals a spectrum of morphology and dysfunction in achalasia that is best characterized by the combination of these studies.

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Section: Principal Findingsmentioning

confidence: 99%

Timed barium esophagram in achalasia types

Zanoni¹,

Rice²,

López³

et al. 2014

Dis Esophagus

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“…The severity of symptoms was evaluated on the basis of a symptom score previously reported by our group. 12,14 The symptom score was the sum of individual scores for five symptoms: dysphagia to solids, dysphagia to liquids, passive regurgitation, active regurgitation and chest pain. The severity of each of these symptoms was scored on a scale of 0-3 as depicted in Table 1.…”

Section: Clinical Evaluationmentioning

confidence: 99%

Efficacy of botulinum toxin injection before pneumatic dilatation in patients with idiopathic achalasia

Mikaeli

Yaghoobi

Montazeri

et al. 2004

Diseases of the Esophagus

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Graded pneumatic dilatation (PD) is an appropriate long-term therapy and botulinum toxin injection (BT) is a relatively short-term therapy in idiopathic achalasia. Their combination has not been previously scrutinized. This study aimed to evaluate the role of BT in enhancing the efficacy of PD with 30 mm balloons. Patients who underwent PD with 30 mm balloons after botulinum toxin injections and a group of age- and sex-matched controls who were treated only with PD were enrolled in the study. Symptom scores were taken before, 1 month after and then every 3 months after PD. There were no significant differences between the two groups in gender, duration or severity of symptoms. One of the 12 patients in the case group relapsed 30 months after PD but the others were in remission for an average of 25.6 months. In the control group, all the patients relapsed after a mean of 12.6 months and needed a 35-mm PD. The cumulative remission rate was significantly higher in the case group compared with the control group (P < 0.01). The mean symptom score decreased by 76% in the case group (P < 0.001) and 53% in the controls (P < 0.01) at the end of the first month. Neither age, sex, nor duration or severity of symptoms were predictive of patients' responses to treatment. It seems that BT may be a meaningful enhancing factor in long-term efficacy of PD. PD with a 30 mm balloon after a BT session may resolve the need for the future higher grade PD.

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“…Marked increase in the esophageal muscle thickness has also been described in a patient with dysphagia in whom the amplitude of contractions and peristalsis were normal, but the duration of contractions was prolonged [5].…”

Section: Discussionmentioning

confidence: 81%

Endoscopic ultrasonography findings in patients with achalasia

et al. 2011

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Aim Patients with achalasia may have a thicker muscularis propria layer than normal subjects. The aim of our study was to determine the prevalence of increased muscle thickness in patients with achalasia measured by endoscopic ultrasonography (EUS) and evaluation of its relationship with disease characteristics. Methods For a 1-year period we studied 16 nonachalsia patients and 16 consecutive achalasia patients before pneumatic dilation. Esophageal muscle thickness was measured at the esophagogastric junction (EGJ), and 5 and 10 cm from the EGJ. Patients' symptom scores and their relief were evaluated 1, 3 and 6 months after treatment. Results Nearly all patients with well-defined achalasia revealed an increase in the muscle thickness relative to controls. There was a correlation between the thickness at 5 and 10 cm above the EGJ and the age of patients with achalasia. Symptom scores, mean lower esophageal pressure, disease duration and response to treatment were not correlated with the rate of increase in muscle thickness. Conclusion Increased esophageal muscle thickness by EUS is likely to be an important marker of achalasia. Sex, symptom score, mean LES pressure, duration of disease and response to treatment were not correlated with muscularis layer thickness.

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Correlation between clinical severity score and the lower esophageal sphincter relaxation pressure in idiopathic achalasia

Abstract: Our study showed that a clinical symptom score can be an appropriate predictor of the LES relaxation pressure in patients with idiopathic achalasia before therapy. Further studies are needed to evaluate similar correlations after therapeutic intervention.

Cited by 18 publications

References 21 publications

Timed barium esophagram in achalasia types

Timed barium esophagram in achalasia types

Efficacy of botulinum toxin injection before pneumatic dilatation in patients with idiopathic achalasia

Endoscopic ultrasonography findings in patients with achalasia

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