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Jankovic J, Milenkovic B, Simic A, Skrobic O, Valipour A, Ivanovic N, Buha I, Milin-Lazovic J, Djurdjevic N, Jandric A, Colic N, Stojkovic S, Stjepanovic M. Influence of Achalasia on the Spirometry Flow-Volume Curve and Peak Expiratory Flow. Diagnostics (Basel) 2024; 14:933. [PMID: 38732346 PMCID: PMC11083519 DOI: 10.3390/diagnostics14090933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 04/25/2024] [Accepted: 04/26/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Achalasia is an esophageal motor disorder characterized by aperistalsis and the failure of the relaxation of the lower esophageal sphincter. We want to find out whether external compression or recurrent micro-aspiration of undigested food has a functional effect on the airway. METHODS The aim of this research was to analyze the influence of achalasia on the peak expiratory flow and flow-volume curve. All of the 110 patients performed spirometry. RESULTS The mean diameter of the esophagus was 5.4 ± 2.1 cm, and nine of the patients had mega-esophagus. Seven patients had a plateau in the inspiratory part of the flow-volume curve, which coincides with the patients who had mega-esophagus. The rest of the patients had a plateau in the expiration part of the curve. The existence of a plateau in the diameter of the esophagus of more than 5 cm was significant (p 0.003). Statistical significance between the existence of a plateau and a lowered PEF (PEF < 80) has been proven (p 0.001). Also, a statistical significance between the subtype and diameter of more than 4 cm has been proved. There was no significant improvement in the PEF values after operation. In total, 20.9% of patients had a spirometry abnormality finding. The frequency of the improvement in the spirometry values after surgery did not differ significantly by achalasia subtype. The improvement in FEV1 was statistically significant compared to the FVC values. CONCLUSIONS Awareness of the influence of achalasia on the pulmonary parameters is important because low values of PEF with a plateau on the spirometry loop can lead to misdiagnosis. The recognition of various patterns of the spirometry loop may help in identifying airway obstruction caused by another non-pulmonary disease such as achalasia.
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Affiliation(s)
- Jelena Jankovic
- Clinic for Pulmonology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (J.J.); (B.M.); (I.B.); (N.D.); (A.J.)
- Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia; (A.S.); (O.S.); (J.M.-L.); (N.C.)
| | - Branislava Milenkovic
- Clinic for Pulmonology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (J.J.); (B.M.); (I.B.); (N.D.); (A.J.)
- Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia; (A.S.); (O.S.); (J.M.-L.); (N.C.)
| | - Aleksandar Simic
- Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia; (A.S.); (O.S.); (J.M.-L.); (N.C.)
- Clinic for Digestive Surgery, University Clinical Centre of Serbia, 11000 Belgrade, Serbia;
| | - Ognjan Skrobic
- Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia; (A.S.); (O.S.); (J.M.-L.); (N.C.)
- Clinic for Digestive Surgery, University Clinical Centre of Serbia, 11000 Belgrade, Serbia;
| | - Arschang Valipour
- Karl Landsteiner Institute for Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Vienna Health Care Group, 1210 Vienna, Austria;
| | - Nenad Ivanovic
- Clinic for Digestive Surgery, University Clinical Centre of Serbia, 11000 Belgrade, Serbia;
| | - Ivana Buha
- Clinic for Pulmonology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (J.J.); (B.M.); (I.B.); (N.D.); (A.J.)
- Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia; (A.S.); (O.S.); (J.M.-L.); (N.C.)
| | - Jelena Milin-Lazovic
- Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia; (A.S.); (O.S.); (J.M.-L.); (N.C.)
- Institute for Medical Statistics and Informatics, University of Belgrade, 11000 Belgrade, Serbia
| | - Natasa Djurdjevic
- Clinic for Pulmonology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (J.J.); (B.M.); (I.B.); (N.D.); (A.J.)
- Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia; (A.S.); (O.S.); (J.M.-L.); (N.C.)
| | - Aleksandar Jandric
- Clinic for Pulmonology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (J.J.); (B.M.); (I.B.); (N.D.); (A.J.)
| | - Nikola Colic
- Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia; (A.S.); (O.S.); (J.M.-L.); (N.C.)
- Center for Radiology and MR, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Stefan Stojkovic
- Clinic for Gastroenterohepatology, University Clinical Center of Serbia, 11000 Belgrade, Serbia;
| | - Mihailo Stjepanovic
- Clinic for Pulmonology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (J.J.); (B.M.); (I.B.); (N.D.); (A.J.)
- Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia; (A.S.); (O.S.); (J.M.-L.); (N.C.)
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Fujiwara Y, Kitagami H, Kikkawa T, Sakashita K, Kusumi T, Nishida Y. Esophageal cancer in an adult with congenital esophageal stenosis: a case report. Surg Case Rep 2024; 10:58. [PMID: 38467897 PMCID: PMC10928053 DOI: 10.1186/s40792-024-01858-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 03/04/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Congenital esophageal stenosis (CES) is a rare condition. We encountered a case of esophageal cancer that developed in an adult with persistent CES. Although many studies have investigated the therapeutic outcomes and performed surveillance for symptoms after treatment for CES, few have performed long-term surveillance or reported on the development of esophageal cancer. We report this case because it is extremely rare and has important implications. CASE PRESENTATION A 45-year-old woman with worsening dysphagia was transferred to our hospital. The patient was diagnosed with CES at 5 years of age and underwent surgery at another hospital. The patient underwent esophageal dilatation for stenosis at 36 years of age. Esophagoscopy performed at our hospital revealed a circumferential ulcerated lesion and stenosis 15-29 cm from the incisors. Histological examination of the biopsy specimen revealed squamous cell carcinoma. Computed tomography (CT) revealed abnormal circumferential wall thickening in parts of the cervical and almost the entire thoracic esophagus. 18F-fluorodeoxyglucose-positron emission tomography-CT revealed increased uptake in the cervical and upper esophagus. No uptake was observed in the muscular layers of the middle or lower esophagus. Based on these findings, the patient was diagnosed with clinical stage IVB cervical and upper esophageal cancer (T3N1M1 [supraclavicular lymph nodes]). The patient underwent a total esophagectomy after neoadjuvant chemotherapy. The esophagus was markedly thickened and tightly adhered to the adjacent organs. Severe fibrosis was observed around the trachea. Marked thickening of the muscular layer was observed throughout the esophagus; histopathological examination revealed that this thickening was due to increased smooth muscle mass. No cartilage, bronchial epithelium, or glands were observed. The carcinoma extended from the cervical to the middle esophagus, oral to the stenotic region. Finally, we diagnosed the patient with esophageal cancer developing on CES of the fibromuscular thickening type. CONCLUSIONS Chronic mechanical and chemical irritations are believed to cause cancer of the upper esophagus oral to a persistent CES, suggesting the need for long-term surveillance that focuses on residual stenosis and cancer development in patients with CES.
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Affiliation(s)
- Yushi Fujiwara
- Department of Gastroenterological Surgery, Keiyukai Sapporo Hospital, Minami1-1, Hondori 9-Chome, Shiroishi-Ku, Sapporo, 003-0026, Japan.
| | - Hidehiko Kitagami
- Department of Gastroenterological Surgery, Keiyukai Sapporo Hospital, Minami1-1, Hondori 9-Chome, Shiroishi-Ku, Sapporo, 003-0026, Japan
| | - Tomohiro Kikkawa
- Department of Gastroenterological Surgery, Keiyukai Sapporo Hospital, Minami1-1, Hondori 9-Chome, Shiroishi-Ku, Sapporo, 003-0026, Japan
| | - Keita Sakashita
- Department of Gastroenterological Surgery, Keiyukai Sapporo Hospital, Minami1-1, Hondori 9-Chome, Shiroishi-Ku, Sapporo, 003-0026, Japan
| | - Takaya Kusumi
- Department of Gastroenterological Surgery, Keiyukai Sapporo Hospital, Minami1-1, Hondori 9-Chome, Shiroishi-Ku, Sapporo, 003-0026, Japan
| | - Yasunori Nishida
- Department of Gastroenterological Surgery, Keiyukai Sapporo Hospital, Minami1-1, Hondori 9-Chome, Shiroishi-Ku, Sapporo, 003-0026, Japan
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Ngian J, Suhitharan T, Desai SR, Liu CW. Severe Achalasia Could Present with Subtle Symptoms. Anesthesiology 2023; 139:665-666. [PMID: 37815469 DOI: 10.1097/aln.0000000000004644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Affiliation(s)
- Jan Ngian
- Department of Anesthesiology, Singapore General Hospital, Singapore
| | - Thangavelautham Suhitharan
- Department of Surgical Intensive Care, Singapore General Hospital, Singapore; Anesthesiology and Perioperative Sciences Academic Clinical Programme, Duke-National University of Singapore Graduate Medical School, Singapore
| | - Suneel Ramesh Desai
- Department of Surgical Intensive Care, Singapore General Hospital, Singapore; Department of Cardiothoracic Anesthesia, National Heart Center, Singapore; Anesthesiology and Perioperative Sciences Academic Clinical Programme, Duke-National University of Singapore Graduate Medical School, Singapore
| | - Christopher W Liu
- Department of Pain Medicine, Singapore General Hospital, Singapore; Anesthesiology and Perioperative Sciences Academic Clinical Programme, Duke-National University of Singapore Graduate Medical School, Singapore
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Han SY, Youn YH. Role of endoscopy in patients with achalasia. Clin Endosc 2023; 56:537-545. [PMID: 37430397 PMCID: PMC10565433 DOI: 10.5946/ce.2023.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 02/22/2023] [Accepted: 03/31/2023] [Indexed: 07/12/2023] Open
Abstract
Achalasia is an esophageal motility disorder characterized by impaired lower esophageal sphincter relaxation and peristalsis of the esophageal body. With the increasing prevalence of achalasia, interest in the role of endoscopy in its diagnosis, treatment, and monitoring is also growing. The major diagnostic modalities for achalasia include high-resolution manometry, esophagogastroduodenoscopy, and barium esophagography. Endoscopic assessment is important for early diagnosis to rule out diseases that mimic achalasia symptoms, such as pseudo-achalasia, esophageal cancer, esophageal webs, and eosinophilic esophagitis. The major endoscopic characteristics suggestive of achalasia include a widened esophageal lumen and food residue in the esophagus. Once diagnosed, achalasia can be treated either endoscopically or surgically. The preference for endoscopic treatment is increasing owing to its minimal invasiveness. Botulinum toxins, pneumatic balloon dilation, and peroral endoscopic myotomy (POEM) are important endoscopic treatments. Previous studies have demonstrated excellent treatment outcomes for POEM, with >95% improvement in dysphagia, making POEM the mainstay treatment option for achalasia. Several studies have reported an increased risk of esophageal cancer in patients with achalasia. However, routine endoscopic surveillance remains controversial owing to the lack of sufficient data. Further studies on surveillance methods and duration are warranted to establish concordant guidelines for the endoscopic surveillance of achalasia.
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Affiliation(s)
- So Young Han
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Young Hoon Youn
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Li MY, Wang QH, Chen RP, Su XF, Wang DY. Pathogenesis, clinical manifestations, diagnosis, and treatment progress of achalasia of cardia. World J Clin Cases 2023; 11:1741-1752. [PMID: 36970002 PMCID: PMC10037292 DOI: 10.12998/wjcc.v11.i8.1741] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/06/2023] [Accepted: 02/21/2023] [Indexed: 03/07/2023] Open
Abstract
Achalasia cardia, type of esophageal dynamic disorder, is a relatively rare primary motor esophageal disease characterized by the functional loss of plexus ganglion cells in the distal esophagus and lower esophageal sphincter. Loss of function of the distal and lower esophageal sphincter ganglion cells is the main cause of achalasia cardia, and is more likely to occur in the elderly. Histological changes in the esophageal mucosa are considered pathogenic; however, studies have found that inflammation and genetic changes at the molecular level may also cause achalasia cardia, resulting in dysphagia, reflux, aspiration, retrosternal pain, and weight loss. Currently, the treatment options for achalasia focus on reducing the resting pressure of the lower esophageal sphincter, helping to empty the esophagus and relieve symptoms. Treatment measures include botulinum toxin injection, inflatable dilation, stent insertion, and surgical myotomy (open or laparoscopic). Surgical procedures are often subject to controversy owing to concerns about safety and effectiveness, particularly in older patients. Herein, we review clinical epidemiological and experimental data to determine the prevalence, pathogenesis, clinical presentation, diagnostic criteria, and treatment options for achalasia to support its clinical management.
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Affiliation(s)
- Ming-Yue Li
- School of Nursing, Binzhou Medical University, Yantai 264003, Shandong Province, China
| | - Qing-Hua Wang
- School of Nursing, Binzhou Medical University, Yantai 264003, Shandong Province, China
| | - Run-Peng Chen
- School of Nursing, Binzhou Medical University, Yantai 264003, Shandong Province, China
| | - Xiao-Fang Su
- School of Nursing, Binzhou Medical University, Yantai 264003, Shandong Province, China
| | - Dong-Yang Wang
- School of Nursing, Binzhou Medical University, Yantai 264003, Shandong Province, China
- Faculty of Nursing, Mahidol University, Nakhon Pathom 73170, Thailand
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Shin CM. How Does Drinking Warm Water Affect Esophageal Preparation Before Peroral Endoscopic Myotomy in Patients With Achalasia? J Neurogastroenterol Motil 2022; 28:171-172. [PMID: 35362446 PMCID: PMC8978120 DOI: 10.5056/jnm22025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 03/07/2022] [Indexed: 11/20/2022] Open
Affiliation(s)
- Cheol Min Shin
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea
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