Back to Search
Start Over
Achalasia symptom response after Heller myotomy segregated by high-resolution manometry subtypes.
- Source :
-
Journal of gastroenterology [J Gastroenterol] 2016 Feb; Vol. 51 (2), pp. 112-8. Date of Electronic Publication: 2015 May 23. - Publication Year :
- 2016
-
Abstract
- Background: Achalasia is classified into three HRM subtypes that predict outcomes from diverse management strategies. We assessed if symptomatic response varied when a single management strategy-Heller myotomy (HM)-is employed.<br />Methods: Treatment-naive subjects with achalasia referred for HM were followed in this observational cohort study. Chicago criteria designated achalasia subtypes (subtype I: no esophageal pressurization; subtype II: panesophageal pressurization in ≥20 % swallows; subtype III: premature contractions in ≥20 % swallows). Symptom questionnaires assessed symptom burden before and after HM on five-point Likert scales (0 = no symptoms, 4 = severe symptoms) and on 10-cm visual analog scales (global symptom severity, GSS); satisfaction with HM was recorded similarly. Data were analyzed to determine predictors of GSS change across subtypes.<br />Results: Sixty achalasia subjects (56.1 ± 2.4 years, 55 % female) fulfilled inclusion criteria, 15 % with subtype I, 58 % with subtype II, and 27 % with subtype III achalasia. Baseline symptoms included dysphagia (solids: 85 %, liquids: 73 %), regurgitation (84 %), and chest pain (35 %); mean GSS was 7.1 ± 0.3. Upon follow-up 2.1 ± 0.2 years after HM, GSS declined to 1.9 ± 0.4 (p < 0.001), with surgical satisfaction score of 8.7 ± 0.3 out of 10; these were similar across achalasia subtypes. On univariate analysis, female gender, Eckardt score, severity of transit symptoms, and maximal IRP predicted linear GSS improvement; female gender (p = 0.003) and dysphagia for liquids (p = 0.043) remained predictive on multivariate analysis.<br />Conclusions: When a uniform surgical approach is utilized, symptomatic outcome and satisfaction with therapy are similar across achalasia subtypes. Female gender and severity of dysphagia for solids may predict better HM outcome.
- Subjects :
- Databases, Factual
Deglutition Disorders etiology
Esophageal Achalasia complications
Esophagoscopy
Female
Follow-Up Studies
Humans
Kidney Failure, Chronic etiology
Male
Manometry
Middle Aged
Patient Satisfaction
Prospective Studies
Severity of Illness Index
Treatment Outcome
Esophageal Achalasia surgery
Esophageal Sphincter, Lower surgery
Subjects
Details
- Language :
- English
- ISSN :
- 1435-5922
- Volume :
- 51
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- Journal of gastroenterology
- Publication Type :
- Academic Journal
- Accession number :
- 26002107
- Full Text :
- https://doi.org/10.1007/s00535-015-1088-6