Evaluation of Esophageal Achalasia: From Symptoms to the Chicago Classification

Neto, Rafael Melillo Laurino; Herbella, Fernando A. M.; Schlottmann, Francisco; Patti, Marco G.

doi:10.1590/0102-672020180001e1376

Cited by 41 publications

(42 citation statements)

References 26 publications

(33 reference statements)

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“…Furthermore, a recent comprehensive review concluded that the diagnosis of achalasia by clinical features is not enough to distinguish this entity from other esophageal diseases and emphasized the need for endoscopy to exclude the presence of cancer. 14 Our results are in accordance with this recommendation because patients with in situ tumors did not experience recurrence after endoscopic resection, and survival outcomes of patients with CMAC that was not promptly diagnosed were associated with shorter PFS and OS, as previously reported. 7 In addition, the prevalence of cancer in Chagasic megaesophagus reported in previous studies is higher (3.9% to 10%) than that reported for achalasia, 6-8 suggesting the involvement of other factors.…”

Section: Discussionsupporting

confidence: 92%

Chagasic Megaesophagus–Associated Carcinoma: Clinical Pattern and Outcomes

Martins

Miyazaki

Gabiatti

et al. 2019

JGO

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PURPOSE Approximately 4% to 10% of patients diagnosed with Chagas-induced megaesophagus disease develop esophageal carcinoma. However, the natural history and clinical pattern of this entity are not well described. METHODS Herein, we retrospectively analyzed 593 patients with esophageal carcinoma treated at a single Brazilian institution. We identified 32 patients with Chagas disease, of whom 11 had megaesophagus. The epidemiologic profile and oncological treatment outcomes were evaluated. RESULTS Although baseline characteristics were similar among the three groups, patients with Chagas megaesophagus–associated carcinoma (CMAC) presented with a lower rate of smoking. This factor reinforced the concept that achalasia is the predominant risk factor for cancer development. The CMAC group had a higher rate of tumor in situ (two of 11 patients) compared with the other groups. These patients were treated with endoscopic resection, and no recurrence was detected. Eight of 11 patients with CMAC were diagnosed with locally advanced disease. Patients with locally advanced CMAC presented with a median progression-free survival of 7.8 months and a median overall survival of 9.1 months. CONCLUSION If CMAC is not promptly detected, it has a dismal prognosis, indicating that a high index of suspicion of esophageal carcinoma is required for patients with Chagasic megaesophagus. Additional studies are needed to improve the surveillance and treatment approaches for this neglected disease.

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Section: Discussionsupporting

confidence: 92%

Chagasic Megaesophagus–Associated Carcinoma: Clinical Pattern and Outcomes

Martins

Miyazaki

Gabiatti

et al. 2019

JGO

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“…9 The most common symptoms of esophageal achalasia are dysphagia and acid regurgitation. 10 It is an uncommon esophageal motility disorder, with a prevalence of around 11 cases per 100,000 individuals. 11 The pathophysiology of achalasia involves the degeneration of inhibitory neurons in the esophageal myenteric plexus but the exact cause remains unknown.…”

Section: Discussionmentioning

confidence: 99%

A Rare Cause of Left Atrium Compression: Esophageal Achalasia

Chen

Toh

Chang

et al. 2020

Preprint

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Background Extrinsic compression of left atrium (LA) due to esophageal achalasia is uncommon. Patients might present with dysphagia, dyspnea, and even hemodynamic compromise. Prompt detection with thorough differential diagnosis is crucial for subsequent management. We presented a case with LA compression by esophageal achalasia, and literature review regarding the clinical manifestation, diagnosis, and treatment strategy was performed to provide an updating knowledge of the disease.Case presentation A 59-year-old relatively healthy man presented with dysphagia accompanied by chest tightness and breathlessness after a large meal. His chest X-ray film disclosed a widened mediastinum. The barium swallow esophagogram revealed contrast pooling at the esophagogastric junction with a bird beak shape. Meanwhile, the transthoracic echocardiogram showed a round-shaped, well bordered, hyperechogenic, and heterogeneous mass (5.1 cm x 3.8 cm in size) compressing the LA irrespective of the systolic or diastolic phase. A chest contrast-enhanced computed tomography scan showed diffuse esophageal dilatation with a smoothly thickening wall aligned compressing the LA. Due to the abovementioned image findings, extrinsic compression of LA by esophageal achalasia was diagnosed.ConclusionLA compression due to esophageal achalasia is not common. Remarkably, given a patient presenting dysphagia and concurrent dyspnea after meals, the clinicians should keep this differential diagnosis in mind. Echocardiography and esophagography are useful to ensure the diagnosis promptly.

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“…Manometric parameters evaluated were those standardized by the International High-Resolution Manometry Working Group in 2015, the Chicago classification 3.0 9 , with the addition of upper esophageal sphincter (UES) basal and relaxation pressures, and LES basal pressure, total and abdominal lengths that were part of the Chicago classification 11 . Data was obtained based on automated analysis by the dedicated software (Esofagica v.1492.…”

Section: Methodsmentioning

confidence: 99%

Validation of a New Water-Perfused High-Resolution Manometry System

Silva

Herbella

Andrade

et al. 2020

ABCD, arq. bras. cir. dig.

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Background: High-resolution manometry is more costly but clinically superior to conventional manometry. Water-perfused systems may decrease costs, but it is unclear if they are as reliable as solid-state systems, and reference values are interchangeable. Aim: To validate normal values for a new water-perfusion high-resolution manometry system. Methods: Normative values for a 24-sensors water perfused high-resolution manometry system were validated by studying 225 individuals who underwent high resolution manometry for clinical complaints. Patients were divided in four groups: group 1 - gastroesophageal reflux disease; group 2 - achalasia; group 3 - systemic diseases with possible esophageal manifestation; and group 4 - dysphagia. Results: In group 1, a hypotonic lower esophageal sphincter was found in 49% of individuals with positive 24 h pH monitoring, and in 28% in pH-negative individuals. In groups 2 and 3, aperistalsis was found in all individuals. In group 4, only one patient (14%) had normal high-resolution manometry. Conclusions: The normal values determined for this low-cost water-perfused HRM system with unique peristaltic pump and helicoidal sensor distribution are discriminatory of most abnormalities of esophageal motility seen in clinical practice.

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Evaluation of Esophageal Achalasia: From Symptoms to the Chicago Classification

Cited by 41 publications

References 26 publications

Chagasic Megaesophagus–Associated Carcinoma: Clinical Pattern and Outcomes

Chagasic Megaesophagus–Associated Carcinoma: Clinical Pattern and Outcomes

A Rare Cause of Left Atrium Compression: Esophageal Achalasia

Validation of a New Water-Perfused High-Resolution Manometry System

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