Analysis of upper esophageal sphincter pressure with symptoms and prognosis in 158 patients with achalasia

Abstract

Objective To investigate upper esophageal sphincter (UES) abnormalities in patients with achalasia (AC), and to analyze the correlation between UES abnormalities and clinical symptoms, treatment efficacy. Methods From February 2012 to December 2014, 158 patients with AC and received high resolution manometry (HRM) examination were retrospectivly analyzed. According to whether with UES abnormalities, patients were divided into UES normal group and UES abnormal group. Patients of UES abnormal group were sub-divided into UES hypotensive group (UES resting pressure 104 mmHg) and impaired relaxation group (residual pressure>12 mmHg). Analysis of Variance, Kruskal-Wallis H test and Chi square test were performed to compare the clinical data and dynamic characteristics of the patients in each group. Results A total of 74 (46.8%) AC patients had UES abnormalities, the majority of whom were impaired relaxation (35 cases, 47.3%). The age of patients in hypotensive group ((60.6±10.1) years) was significantly older than that of hypertensive group ((43.9±11.1) years) and impaired relaxation group ((46.8±16.3) years), and the disease course (10 years, 4 to 30 years) was obviously longer than that of hypertensive group (6 years, 1 to 10 years) and impaired relaxation group (8 years, 3 to 15 years), and the differences were statistically significant (F=7.983, H=13.816, both P 0.05). The results of AC subtyping indicated that type Ⅱ AC accounted 55.7% (88/158). Type Ⅱ AC cases number of UES normal group and abnormal group was 46 and 42 cases, both was majority (54.8% and 56.8%). Among these patients, 123 patients finally received peroral endoscopic myotomy (POEM), 47.2%(58/123) of whom had abnormal UES. More than 85% patients were satisfied at one month after the operation. And Eckardt scores significantly decreased. There was no significant difference in treatment efficacy between the two groups. Conclusions Most AC patients are with UES abnormality, and impaired relaxation is more common. There is no correlation between UES abnormalities and major symptoms. There is no predictive role of UES abnormalities in treatment efficacy of POEM in AC patients. Key words: High resolution esophageal manometry; Esophageal sphincter, upper; Achalasia; Peroral endoscopic myotomy