Subtype of Achalasia and Integrated Relaxation Pressure Measured Using the Starlet High-resolution Manometry System: A Multicenter Study in Japan

Abstract

Background/AimsManoScan and Sandhill high-resolution manometry (HRM) systems are used worldwide; however, the diagnosis of achalasia on the Starlet HRM system is not fully characterized. Furthermore, the impact of calcium channel blockers and nitrites in treating achalasia has not been investigated using HRM. Management of recurrent cases is a priority issue, although few studies have examined patient characteristics. MethodsWe conducted a multicenter, large-scale database analysis. First, the diagnosis of treatment-naive achalasia in each HRM system was investigated. Next, patient characteristics were compared between type I-III achalasia, and the impact of patient characteristics, including calcium channel blocker and nitrite use for integrated relaxation pressure (IRP) values, were analyzed. Finally, patient characteristics with recurrent achalasia were elucidated. ResultsThe frequency of type I achalasia with Starlet was significantly higher than that with ManoScan and Sandhill HRM systems. In achalasia, multivariate analysis identified male sex, advanced age, long disease duration, obesity, type I achalasia, and sigmoid type as risk factors related to normal IRP values (< 26 mmHg). Calcium channel blockers and nitrites use had no significant impact on the IRP values, although achalasia symptoms were indicated to be alleviated. In recurrent cases, the IRP value was significantly lower, and advanced age, long disease duration, and sigmoid type were more common than in treatment-naive patients. ConclusionsWe should cautiously interpret the type of achalasia and IRP values in the Starlet HRM system. Symptoms of recurrent cases are related to disease progression rather than IRP values, which should be considered in decision making.

Correlation between Lower Esophageal Sphincter Metrics on High-Resolution Manometry and the Clinical Presentation of Patients with Newly Diagnosed Achalasia

“…Demographics are known to play a role in IRP. Similar to our findings, male gender and older age have been previously reported to be associated with lower IRP values in achalasia patients [ 13 , 14 ]. Surprisingly, our study found ethnicity to be even more significantly associated with IRP values.…”

Clinical characteristics of absent contractility and ineffective esophageal motility: a multicenter study in Japan

“…We conducted a multicenter study involving 14 high-volume centers in Japan, namely, the Japan Achalasia Multicenter study (JAMS) and analyzed a large number of patients with EMDs. 10,13 Consecutive series of patients with EMDs diagnosed using standard methods, including HRM, esophagography, and esophagogastroscopy, from 2010 and 2020, were enrolled in the JAMS. All diagnoses were performed by experts with extensive experience in the diagnosis of EMDs.…”

“…Consequently, the characteristics of patients in these disorders should be clarified to help differential diagnosis, and the cut-off values of the intraluminal pressure at EGJ should be established. In Starlet HRM, the frequency of type I achalasia diagnosis is relatively higher than that of type II, different from the Manoscan or Sandhill HRM systems 10 ; therefore, the opportunity to concern the differential diagnosis is considered much higher.…”

Implementation of the Naïve Bayes Method in Expert Systems for Diagnosing Achalasia

“…Pada penilitian Tetsuya Tatsuta, Dkk (2022) disimpulkan bahwa penghambat saluran kalsium dapat meringankan gejala, meskipun tidak dengan mengurangi nilai integrated relaxation pressure. Kasus akalsia yang berulang memiliki karakteristik pasien yang berbeda, dan strategi terbaik harus ditentukan berdasarkan hal ini (Tatsuta et al, 2022).…”