Relationships between endosonographic appearance and clinical or manometric features in patients with achalasia

Barthet, Marc; Mambrini, P.; Audibert, P; Boustière, Christian; Helbert, Thierry; Bertolino, J.; Peyrot, J; Salducci, J; Grimaud, Jean–Charles

doi:10.1097/00042737-199807000-00006

Cited by 22 publications

(9 citation statements)

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“…When evaluating the LES, the total wall thickness, but not the muscularis propria thickness was significantly greater in patients with IRP≥15 mmHg compared to patients with IRP<15 mmHg (p=0.01). These measurements are considerably greater than reported in historical controls 8–11, 16 (mean total wall thickness 3.3 mm and muscularis propria thickness 1.0 mm). Overall, among patients with IRP≥15, those with EGJOO were found to have the greatest esophageal wall, muscularis propria, and LES thickness whereas among patients with IRP<15, those with DES had greatest wall thickness.…”

Section: Resultscontrasting

confidence: 60%

“…Hence, the addition of imaging modalities such as intraluminal and extraluminal ultrasound may be useful adjuncts. Early studies evaluating esophageal wall thickness in patients with achalasia using endoscopic ultrasound (EUS) reported heterogeneous findings with regard to wall and muscle thickness 8–1011 . A more recent investigation utilized a novel intraluminal manometry/ultrasound probe and reported marked thickening of the musclaris propria in patients with achalasia and hypercontractile conditions compared to control patients 12 .…”

Section: Introductionmentioning

confidence: 99%

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Endoscopic ultrasound as an adjunctive evaluation in patients with esophageal motor disorders subtyped by high‐resolution manometry

Krishnan

Lin

Keswani

et al. 2014

Neurogastroenterology Motil

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Background and aims Esophageal motor disorders are a heterogenous group of conditions identified by esophageal manometry that lead to esophageal dysfunction. The aim of this study was to assess the clinical utility of endoscopic ultrasound in the further evaluation of patients with esophageal motor disorders categorized using the updated Chicago Classification. Methods We performed a retrospective, single center study of 62 patients with esophageal motor disorders categorized according to the Chicago Classification. All patients underwent standard radial endosonography to assess for extra esophageal findings or alternative explanations for esophageal outflow obstruction. Secondary outcomes included esophageal wall thickness among the different patient subsets within the Chicago Classification Key Results EUS identified 9/62 (15%) clinically relevant findings that altered patient management and explained the etiology of esophageal outflow obstruction. We further identified substantial variability in esophageal wall thickness in a proportion of patients including some with a significantly thickened non-muscular layer. Conclusions EUS findings are clinically relevant in a significant number of patients with motor disorders and can alter clinical management. Variability in esophageal wall thickness of the muscularis propria and non-muscular layers identified by EUS may also explain the observed variability in response to standard therapies for achalasia.

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Section: Resultscontrasting

confidence: 60%

Section: Introductionmentioning

confidence: 99%

Endoscopic ultrasound as an adjunctive evaluation in patients with esophageal motor disorders subtyped by high‐resolution manometry

Krishnan

Lin

Keswani

et al. 2014

Neurogastroenterology Motil

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“…Morphologically and pathophysiologically, achalasia is characterised by an imbalance of excitatory and inhibitory neural inputs in the lower oesophageal sphincter region [4] Thus, it has been demonstrated that the neurons containing the inhibitory neurotransmitters nitric oxide and vasoactive intestinal polypeptide (VIP) are specifically absent in the sphincter region [5,6]. Endoscopic ultrasound or computed tomography (CT) examinations performed in achalasia patients often show a thickening of the muscle layers in the lower oesophageal sphincter (LOS) [7,8]. …”

Section: Introductionmentioning

confidence: 99%

Treatment of achalasia: the short-term response to botulinum toxin injection seems to be independent of any kind of pretreatment

et al. 2002

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BackgroundIt has been suggested that intrasphincteric injection of botulinum toxin (BTX) may represent an alternative therapy to balloon dilatation in achalasia. The aim of the present study was to test the effectiveness of botulinum toxin injections in achalasia patients, as assessed using lower oesophageal sphincter pressure (LOSP) and symptom scores, and to compare the response in patients with different types of pretreatment (no previous treatment, balloon dilatation, myotomy, BTX injection).MethodsForty patients who presented with symptomatic achalasia were treated with BTX injection (48 injections in 40 patients). Some of the patients had received prior treatment (seven with myotomy, seven with dilatation and eight with BTX). The symptoms were assessed using a global symptom score (0–10), which was evaluated before treatment, 1 week afterwards, and 1 month afterwards. Manometry was also carried out before and after treatment. Three different selections of patients were studied: all patients; untreated patients; and patients with prior BTX, dilatation, or myotomy.ResultsAfter BTX injection, there was a significant reduction in LOSP (before, 38.2 ± 11.3 mmHg; 1 week after, 20.5 ± 6.9 mmHg; 1 month after, 17.8 ± 6.8 mmHg; P < 0.001). The global symptom score and symptom subscores (dysphagia, regurgitation, chest pain) were significantly decreased after 1 week and 1 month. When the beneficial effects following BTX injection were compared (untreated vs. pretreated), neither changes in LOSP nor beneficial effects on the symptom scores significantly differed. After 6 months, 67.7% of all treated patients were still in symptomatic remission (subgroups: previously untreated patients, 61.5%, n = 26; prior dilatation, 71.4%, n = 7; prior myotomy, 71.4%, n = 7; prior BTX, 73.9%, n = 8).ConclusionsBTX injection offers an alternative treatment for achalasia which is safe and can be performed in an outpatient setting. The initial response to BTX, in terms of symptom scores and LOSP, appears to be independent of any prior treatment. A number of patients do not adequately respond to balloon dilatation or myotomy, which are the first-line treatment modalities in achalasia patients. BTX injection can be performed in these patients, and symptomatic benefit can be expected in the same percentages as with BTX injection in untreated patients.

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“…However, taking the analogy of achalasia cardia, which is a motility disorder of esophagus, thicker lower esophageal sphincter is associated with poorer esophageal emptying and poorer response to treatment. [28][29][30][31][32][33][34][35][36] Interestingly, a large proportion of patients with SRU had constipation using the Rome III criteria and used laxatives in spite of passing type IV and even types V and VI stool; the latter types of stools are diagnostic of diarrhea according to the recent Asian consensus. 37 Such discordance might be explained by the fact that in the presence of FED, it may be difficult to evacuate even the liquid stool due to functional obstruction of anorectal outlet.…”

Section: Discussionmentioning

confidence: 99%

Fecal Evacuation Disorder Among Patients With Solitary Rectal Ulcer Syndrome: A Case-control Study

Sharma

Misra

Ghoshal

2014

J Neurogastroenterol Motil

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Background/Aims Data on frequency of fecal evacuation disorder (FED) among patients with solitary rectal ulcer syndrome (SRUS), hitherto an enigmatic condition, are scanty. Moreover, most such studies had limitations due to small sample size and lack of inclusion of healthy controls (HC). Methods Forty patients with SRUS underwent symptom assessments, sigmoidoscopy, anorectal manometry, defecography, balloon expulsion test (BET); endoscopic ultrasound (EUS) of anal sphincter complex was performed in a subgroup. Physiological tests (anorectal manometry and BET) were also performed in 19 HC. Results Patients with SRUS (26/40 male, age 37 [18–80] years) more often had FED than HC (10/19 male, age 43 [25–72] years) as shown by weight needed to expel the balloon (300 [0–700] g vs. 100 [0–400] g; P = 0.006), a trend towards abnormal BET (need of > 200 g weight for expulsion) (21/40 [53%] vs. 5/19 [26%], P = 0.058) and impaired anal relaxation (14/40 [35%] vs 2/19 [10.5%]; P = 0.048). Using Rome III criteria, most patients with SRUS reported having chronic constipation (36/40 [90%]) in spite of having normal (Bristol stool type IV, 21/40 [53%]) and diarrheal (types V, VI, VII, 6/40 [20%]) stool forms (Asian classification). SRUS patients more often (17/40 [43%]) had functional defecation disorder (Rome III criteria). Patients with SRUS with abnormal BET had thicker internal anal sphincter than those without (3.9 [3.4–7.0] mm vs 2.8 [2.0–4.0] mm; P = 0.01). Conclusions FED was commoner among patients with SRUS as evidenced by abnormal BET and sphincter relaxation. Those with abnormal BET had thicker internal sphincter on EUS than those without.

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Relationships between endosonographic appearance and clinical or manometric features in patients with achalasia

Cited by 22 publications

References 0 publications

Endoscopic ultrasound as an adjunctive evaluation in patients with esophageal motor disorders subtyped by high‐resolution manometry

Endoscopic ultrasound as an adjunctive evaluation in patients with esophageal motor disorders subtyped by high‐resolution manometry

Treatment of achalasia: the short-term response to botulinum toxin injection seems to be independent of any kind of pretreatment

Fecal Evacuation Disorder Among Patients With Solitary Rectal Ulcer Syndrome: A Case-control Study

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