1
|
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.
Collapse
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.)
| |
Collapse
|
2
|
Jankovic J, Milenkovic B, Skrobic O, Ivanovic N, Djurdjevic N, Buha I, Jandric A, Colic N, Milin-Lazovic J. Achalasia Subtype Differences Based on Respiratory Symptoms and Radiographic Findings. Diagnostics (Basel) 2023; 13:2198. [PMID: 37443591 DOI: 10.3390/diagnostics13132198] [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: 04/28/2023] [Revised: 06/07/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023] Open
Abstract
Three subtypes of achalasia have been defined using esophageal manometry. Several studies have reported that symptoms are experienced differently among men and women, regardless of subtype. All subtypes could have some impact on the appearance of respiratory symptoms and lung complications due to compression of the trachea or aspiration of undigested food. The aim of this research was to analyze the differences in respiratory symptoms and radiographic presentation of lung pathology depending on the diameter and achalasia types. One or more respiratory symptoms were reported in 48% of 114 patients, and all of them had two or more gastrointestinal symptoms. The symptom score (SS) is statistically significant for the prediction of subtype 1 (area under the curve = 0.318; p < 0.001, cut-off score of 6.5 had 95.2% sensitivity) and subtype 2 (area under the curve = 0.626; p = 0.020, cut-off score of 7.5 had 93.1% sensitivity). The most common type was subtype 2 (50.8%), and although only 14 patients had subtype 3, they had the largest esophageal diameter (mean 5.8 cm). The difference in esophageal diameter was significant between subtype 1 and 3 (p = 0.011), subtype 2 and subtype 3 (p = 0.011). Nine patients (6%) had mega-esophagus (four patients in type 1, three in type 2 and two in type 3). More than half of all patients (51.7%) had at least one parenchymal lung change on CT scan. Recurrent micro-aspirations led to changes in the structure of the airways and lung parenchyma such as ground glass (GGO) and nodular changes (12%) and fibrosis (14.5%), and they had higher esophageal diameters (p < 0.001). Patients with chronic lung CT changes had significantly higher esophageal diameter than with acute changes (p < 0.001). Awareness of the association of achalasia and lung disorders is important in early diagnosis and treatment. More than half (57.5%) of patients with achalasia had some clinical and/or structural pulmonary abnormalities. All three subtypes had similar respiratory symptoms, meaning they cannot be used to predict the subtype of achalasia; on the contrary, SS can predict the first two subtypes. A higher diameter of the esophagus is associated with chronic structural lung changes. Although unexpected, the pathological radiological findings and diameter were significantly different in subtype 3 patients, but those parameters cannot lead us to a specified subtype.
Collapse
Affiliation(s)
- Jelena Jankovic
- Clinic for Pulmonology, University Clinical Center of Serbia, 11000 Belgrade, Serbia
- Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia
| | - Branislava Milenkovic
- Clinic for Pulmonology, University Clinical Center of Serbia, 11000 Belgrade, Serbia
- Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia
| | - Ognjan Skrobic
- Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia
- Clinic for Digestive Surgery, First Surgical University Hospital, Clinical Centre of Serbia, 11000 Belgrade, Serbia
| | - Nenad Ivanovic
- Clinic for Digestive Surgery, First Surgical University Hospital, Clinical Centre of Serbia, 11000 Belgrade, Serbia
| | - Natasa Djurdjevic
- Clinic for Pulmonology, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Ivana Buha
- Clinic for Pulmonology, University Clinical Center of Serbia, 11000 Belgrade, Serbia
- Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia
| | - Aleksandar Jandric
- Clinic for Pulmonology, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Nikola Colic
- Center for Radiology and MR, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Jelena Milin-Lazovic
- Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia
- Institute for Medical Statistics and Informatics, University of Belgrade, 11000 Belgrade, Serbia
| |
Collapse
|
3
|
Shiota S, Kuribayashi R, Utsunomiya R, Miyazaki E. Esophageal achalasia: An unusual reason for lung abscess. J Gen Fam Med 2022; 23:189-190. [PMID: 35509343 PMCID: PMC9062546 DOI: 10.1002/jgf2.518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 12/16/2021] [Accepted: 01/06/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
- Seiji Shiota
- Department of General Medicine Oita University Faculty of Medicine Yufu Oita Japan
| | - Ryoko Kuribayashi
- Department of General Medicine Oita University Faculty of Medicine Yufu Oita Japan
| | - Rie Utsunomiya
- Department of General Medicine Oita University Faculty of Medicine Yufu Oita Japan
| | - Eishi Miyazaki
- Department of General Medicine Oita University Faculty of Medicine Yufu Oita Japan
| |
Collapse
|
4
|
Long-term Outcomes of Laparoscopic Heller’s Cardiomyotomy in Achalasia Cardia With Megaesophagus. Surg Laparosc Endosc Percutan Tech 2021; 31:175-180. [PMID: 32890251 DOI: 10.1097/sle.0000000000000854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 07/28/2020] [Indexed: 11/27/2022]
|
5
|
Abstract
Purpose of the review Gastroesophageal reflux disease (GERD) is frequently implicated as a cause for respiratory disease. However, there is growing evidence that upper gastrointestinal dysmotility may play a significantly larger role in genesis of respiratory symptoms and development of underlying pulmonary pathology. This paper will discuss the differential diagnosis for esophageal and gastric dysmotility in aerodigestive patients and will review the key diagnostic and therapeutic interventions for this dysmotility. Recent findings Previous studies have shown an association between GERD and pulmonary pathology in children with aerodigestive disorders. Recent publications have demonstrated the presence of esophageal and gastric dysfunction, using fluoroscopic and nuclear medicine studies, in aerodigestive patients who commonly present to pulmonary and otolaryngology clinics. High-resolution impedance manometry (HRIM) has revolutionized our understanding of esophageal dysmotility and its role in pathogenesis of aspiration and esophageal dysfunction and subsequent respiratory compromise. Summary Esophageal and gastric dysmotility have a profound effect on development of respiratory symptoms and pulmonary sequalae in aerodigestive patients. However, our understanding of the pathophysiology is in its infancy. Prospective studies in are needed to address key clinical questions such as: What degree of dysmotility initiates respiratory compromise? What diagnostic tests and therapeutic options best predict aerodigestive outcomes?
Collapse
|
6
|
Mazzola P, Carissimi F, Floris P, Pittella F, Galeazzi M, Moretti D, Bellelli G, Dinelli M, Annoni G. Megaesophagus in an elderly man with achalasia: a "not so benign" condition. Aging Clin Exp Res 2017; 29:809-814. [PMID: 27714664 DOI: 10.1007/s40520-016-0633-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 09/16/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Paolo Mazzola
- Acute Geriatrics Unit, School of Medicine and Surgery, University of Milano-Bicocca, Via Pergolesi, 33, 20900, Monza, MB, Italy.
- Clinical Neurosciences Research Area, NeuroMI - Milan Center for Neuroscience, 20126, Milan, MI, Italy.
| | | | - Patrizia Floris
- Acute Geriatrics Unit, School of Medicine and Surgery, University of Milano-Bicocca, Via Pergolesi, 33, 20900, Monza, MB, Italy
| | - Francesca Pittella
- Acute Geriatrics Unit, School of Medicine and Surgery, University of Milano-Bicocca, Via Pergolesi, 33, 20900, Monza, MB, Italy
| | - Marianna Galeazzi
- Acute Geriatrics Unit, School of Medicine and Surgery, University of Milano-Bicocca, Via Pergolesi, 33, 20900, Monza, MB, Italy
| | - Daniela Moretti
- Acute Geriatrics Unit, San Gerardo Hospital ASST Monza, Monza, Italy
| | - Giuseppe Bellelli
- Acute Geriatrics Unit, School of Medicine and Surgery, University of Milano-Bicocca, Via Pergolesi, 33, 20900, Monza, MB, Italy
- Clinical Neurosciences Research Area, NeuroMI - Milan Center for Neuroscience, 20126, Milan, MI, Italy
- Acute Geriatrics Unit, San Gerardo Hospital ASST Monza, Monza, Italy
| | - Marco Dinelli
- Endoscopy Unit, San Gerardo Hospital ASST Monza, Monza, Italy
| | - Giorgio Annoni
- Acute Geriatrics Unit, School of Medicine and Surgery, University of Milano-Bicocca, Via Pergolesi, 33, 20900, Monza, MB, Italy
- Clinical Neurosciences Research Area, NeuroMI - Milan Center for Neuroscience, 20126, Milan, MI, Italy
- Acute Geriatrics Unit, San Gerardo Hospital ASST Monza, Monza, Italy
| |
Collapse
|
7
|
Anesthesia in per-oral endoscopic myotomy: A large tertiary care centre experience. Indian J Gastroenterol 2017; 36:305-312. [PMID: 28840505 DOI: 10.1007/s12664-017-0782-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 07/26/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVES Per-oral endoscopic myotomy (POEM) is safe and efficacious for the management of achalasia cardia (AC). POEM is usually performed under general anesthesia in an endoscopy suite or operating theatre. The current study was conducted with the aim to analyse anesthetic management of patients with AC who underwent POEM at our institution. METHODS We retrospectively analysed the data of patients with AC who underwent POEM at our institution from January 2013 to September 2016. All cases were performed in an endoscopy suite under supervision of an anesthesia management team. Pre-procedure endoscopic evacuation of esophagogastric contents was done in all cases. Management strategies used for gas-related adverse events and outcomes were assessed. RESULTS Four hundred and eighty patients (median age 40 years, range 4-77 years) underwent POEM during the study period. The sub-types of AC were type I (163), type II (297), and type III (20). POEM was successfully completed in 97.5% patients. Gas-related events were noted in 30.6% cases including-capno-thorax in 1%, capno-peritoneum in 12.3%, retroperitoneal air in 16.5%, capno-mediastinum in 0.2%, and capno-pericardium in 0.4% patients. Significant rise in end tidal CO2 (> 45) and peak airway pressure were observed in 8.1% and 5.4% cases, respectively. Drainage was required in 12.3% patients. There was no occurrence of aspiration during or after POEM. CONCLUSIONS POEM could be safely performed in an endoscopy suite under supervision of an expert anesthesia management team. Gas-related adverse events were common during POEM and could be managed with a standardized approach.
Collapse
|
8
|
Andolfi C, Kavitt RT, Herbella FA, Patti MG. Achalasia and Respiratory Symptoms: Effect of Laparoscopic Heller Myotomy. J Laparoendosc Adv Surg Tech A 2016; 26:675-9. [DOI: 10.1089/lap.2016.0246] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ciro Andolfi
- Department of Surgery and Center for Esophageal Diseases, University of Chicago Pritzker School of Medicine, Chicago, Illinois
| | - Robert T. Kavitt
- Department of Gastroenterology, University of Chicago Pritzker School of Medicine, Chicago, Illinois
| | - Fernando A.M. Herbella
- Department of Surgery, Escola Paulista de Medicina, Federla University of Sao Paulo, Sao Paulo, Brazil
| | - Marco G. Patti
- Department of Surgery and Center for Esophageal Diseases, University of Chicago Pritzker School of Medicine, Chicago, Illinois
| |
Collapse
|
9
|
Molena D, Mungo B, Stem M, Lidor AO. Hospitalization for esophageal achalasia in the United States. World J Gastrointest Endosc 2015; 7:1096-1102. [PMID: 26421106 PMCID: PMC4580951 DOI: 10.4253/wjge.v7.i13.1096] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 05/02/2015] [Accepted: 09/08/2015] [Indexed: 02/05/2023] Open
Abstract
AIM: To assess the outcome of different treatments in patients admitted for esophageal achalasia in the United States.
METHODS: This is a retrospective analysis using the Nationwide Inpatient Sample over an 8-year period (2003-2010). Patients admitted with a primary diagnosis of achalasia were divided into 3 groups based on their treatment: (1) Group 1: patients who underwent Heller myotomy during their hospital stay; (2) Group 2: patients who underwent esophagectomy; and (3) Group 3: patients not undergoing surgical treatment. Primary outcome was in-hospital mortality. Secondary outcomes included length of stay (LOS), discharge destination and total hospital charges.
RESULTS: Among 27141 patients admitted with achalasia, nearly half (48.5%) underwent Heller myotomy, 2.5% underwent esophagectomy and 49.0% had endoscopic or other treatment. Patients in group 1 were younger, healthier, and had the lowest mortality when compared with the other two groups. Group 2 had the highest LOS and hospital charges among all groups. Group 3 had the highest mortality (1.2%, P < 0.001) and the lowest home discharge rate (78.8%) when compared to the other groups. The most frequently performed procedures among group 3 were esophageal dilatation (25.9%) and injection (13.3%). Among patients who died in this group the most common associated morbidities included acute respiratory failure, sepsis and aspiration pneumonia.
CONCLUSION: Surgery for achalasia carries exceedingly low mortality in the modern era; however, in complicated patients, even less invasive treatments are burdened by significant mortality and morbidity.
Collapse
|
10
|
Cheung WK, Ho MP, Chou AH. Delayed discovery and diagnosis of achalasia resulting in megaesophagus in an elderly nursing home resident. J Am Geriatr Soc 2015; 63:201-3. [PMID: 25597584 DOI: 10.1111/jgs.13219] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Wing-Keung Cheung
- Division of Medical Imaging, Department of Radiology, Far Eastern Memorial Hospital, and Oriental Institute of Technology, New Taipei City, Taiwan
| | | | | |
Collapse
|
11
|
Kwon HY, Lim JH, Shin YW, Kim CW. A case of chronic cough caused by achalasia misconceived as gastroesophageal reflux disease. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2014; 6:573-6. [PMID: 25374758 PMCID: PMC4214979 DOI: 10.4168/aair.2014.6.6.573] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2013] [Revised: 11/11/2013] [Accepted: 12/02/2013] [Indexed: 02/04/2023]
Abstract
Cough is one of the most common symptoms that causes patients to seek outpatient medical care. If cough persists longer than 8 weeks, common causes of chronic cough, such as upper airway cough syndrome, asthma, and gastroesophageal reflux disease (GERD), should be considered. Although not a common cause of chronic cough, achalasia may cause symptoms very similar to reflux that can lead to its misdiagnosis as GERD. In this report, a 40-year-old woman presenting with chronic cough was initially diagnosed with GERD; however, her symptoms were refractory to conventional GERD treatment. Finally, she was diagnosed with achalasia. Her cough improved completely after pneumatic dilatation. Achalasia is a rare disease accompanied by dysphagia or regurgitation. If cough presumably due to GERD does not respond to treatment, or if the cause of chronic cough is uncertain, physicians should suspect achalasia.
Collapse
Affiliation(s)
- Hea Yoon Kwon
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Jun Hyeok Lim
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Yong Woon Shin
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Cheol-Woo Kim
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| |
Collapse
|
12
|
Gupta M, Ghoshal UC, Jindal S, Misra A, Nath A, Saraswat VA. Respiratory dysfunction is common in patients with achalasia and improves after pneumatic dilation. Dig Dis Sci 2014; 59:744-52. [PMID: 24357183 DOI: 10.1007/s10620-013-2971-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Accepted: 11/19/2013] [Indexed: 12/09/2022]
Abstract
BACKGROUND Dysphagia, regurgitation, and chest pain are common achalasia, with a variable report of pulmonary symptoms possibly due to micro-aspiration. Pneumatic dilation (PD) may improve pulmonary function. Data on pulmonary dysfunction among achalasia patients are scanty, and the effect of PD is unknown. AIM To evaluate pulmonary dysfunction in patients with achalasia based on clinical and radiologic evaluation and spirometry and to study the effect of PD at 1-month follow-up. METHODS Patients with achalasia (diagnosed using high-resolution manometry and the Chicago classification) were evaluated prospectively by spirometry before (n = 38) and 1 month after PD (n = 31). All patients received a chest X-ray, and patients with respiratory abnormality before PD received high-resolution computed tomography of the thorax. RESULTS Of the 38 patients, 17 and 21 had type I and II achalasia, respectively. The respiratory symptoms, such as pharyngeal symptoms [27/38 (71 %) vs. 8/31 (26 %); P = 0.0001], cough [23/38 (60.5 %) vs. 5/31 (16 %), P = 0.0001], and dyspnea [8/38 (21 %) vs. 0/31 (0 %), P = 0.006], improved after treatment with PD. Spirometry showed abnormalities in 17/38 (45 %) patients before and in 8/15 (53 %) after PD. Median FEV(1), FVC, PEFR, and percentage of predicted MEF(25-75), improved from 78 % (36-85), 74 % (48-100), 62 % (18-72), and 48 % (15-66) before to 83 % (58-94), 86 % (55-99), 69 % (38-81), and 59 % (33-78) after PD, respectively (P < 0.05 for all). CONCLUSION Respiratory symptoms and spirometry abnormalities are common in patients with achalasia and improved after successful PD.
Collapse
Affiliation(s)
- Mahesh Gupta
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India
| | | | | | | | | | | |
Collapse
|
13
|
Molena D, Mungo B, Stem M, Feinberg RL, Lidor AO. Outcomes of esophagectomy for esophageal achalasia in the United States. J Gastrointest Surg 2014; 18:310-7. [PMID: 23963868 DOI: 10.1007/s11605-013-2318-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Accepted: 08/06/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND While the outcomes after Heller myotomy have been extensively reported, little is known about patients with esophageal achalasia who are treated with esophagectomy. METHODS This was a retrospective analysis using the Nationwide Inpatient Sample over an 11-year period (2000-2010). Patients admitted with a primary diagnosis of achalasia who underwent esophagectomy (group 1) were compared to patients with esophageal cancer who underwent esophagectomy (group 2) during the same time period. Primary outcome was in-hospital mortality. Secondary outcomes included length of stay, postoperative complications, and total hospital charges. A propensity-matched analysis was conducted comparing the same outcomes between group 1 and well-matched controls in group 2. RESULTS Nine hundred sixty-three patients with achalasia and 18,003 patients with esophageal cancer underwent esophagectomy. The propensity matched analysis showed a trend toward a higher mortality in group 2 (7.8 vs. 2.9 %, p = 0.08). Postoperative length of stay and complications were similar in both groups. Total hospital charges were higher for the achalasia group ($115,087 vs. $99, 654.2, p = 0.006). CONCLUSION This is the largest study to date examining outcomes after esophagectomy in patients with achalasia. Based on our findings, esophagectomy can be considered a safe option, and surgeons should not be hindered by a perceived notion of prohibitive operative risk in this patient population.
Collapse
Affiliation(s)
- Daniela Molena
- Division of Thoracic Surgery, Department of Surgery, Johns Hopkins University, 600 N Wolfe Street, Blalock 240, Baltimore, MD, 21287, USA,
| | | | | | | | | |
Collapse
|