贲门失弛缓症贲门扩张前后食管测压变化

贲门失弛缓症是一种原发性食管神经肌肉病变,以下食管括约肌(LES)松弛障碍、食管体部缺乏蠕动性收缩为特点的动力障碍性疾病。扩张疗法是主要治疗方法,从2 0 0 0年7月始,我们对1 0例贲门失弛缓症患者的扩张治疗效果进行了食管测压研究。一、资料和方法1 .对象:确诊为贲门失弛缓症的住院患者1 0例,其中男5例,女5例,年龄1 9～5 7岁;病程3～1 2 0个月,平均(39 8±37 5 )个月。2 .治疗方法:采用探条扩张法或气囊扩张法。扩张器分别为Wilson Cook公司的Savary探条和专用贲门失弛缓症扩张气囊。3.食管动力检查:扩张前1d及扩张结束后2d行食管测…     

食管压力测定在贲门失弛缓症诊治中的应用及评价

目的 研究贲门失弛缓症患者全覆膜防反流食管支架治疗前后食管压力变化.方法 对30例贲门失弛缓症患者经全覆膜防反流食管支架治疗前后食管压力测定数据进行分析.结果 贲门失弛缓症患者食管下括约肌静息压(LESP)较扩张前显著下降(P<0.05),食管下括约肌松弛率(LESRR)明显提高(P<0.05);支架治疗后食管体部同步收缩峰值增高,食管体部静息压降低(P<0.05),扩张后食管体部同步收缩波与扩张前比较无显著变化.结论 食管压力测定可用于评价全覆膜防反流食管支架治疗贲门失弛缓症的疗效.     

食管测压在贲门失弛缓症诊治中的应用及评价

目的　研究贲门失弛缓症患者的食管压力变化。方法　对 35例贲门失弛缓症患者与 30位正常对照的食管测压数据进行对比分析。结果　贲门失弛缓症组食管体部均为同步蠕动波 ,91 4 % (32 / 35 )为低幅同步收缩波 ;食管下括约肌松弛率 (LESRR)为 (6 9 1± 16 3) % ,明显低于正常对照的 (96 0± 0 1) % (P <0 0 1) ;食管下括约肌压增加 ;食管上括约肌各项指标与正常对照组比较无明显差别。结论　贲门失弛缓症的食管压力以低幅同步收缩波和LESRR增高为特征性表现。     

老年贲门失弛缓症诊治进展

<正>贲门失弛缓症(AC)是一种原发性食管动力障碍性疾病,典型的特征为下食管括约肌(LES)松弛障碍导致的食管流出道梗阻[1]。主要诊断方法包括钡餐透视、CT、内镜、高分辨率食管测压(HRM)等。随着HRM的广泛应用,其已成为诊断AC的"金标准",在AC分型、指导手术方案的选择及疗效评估等方面发挥了重要的作用。但因为AC发病机制不明,难以从病因上得到治愈[2]。随着老年人群AC发病率升高,老年AC诊断的标准化及治疗方式的选择逐渐成为研究的热点     

贲门失弛缓症气囊扩张前后食管测压指标的变化

贲门失弛缓症病因未明 ,多数人认为是迷走神经及其背核和食管壁肌间神经丛神经节细胞变性乃至消失 ,使得食管体部缺少蠕动和下食管括约肌 (LES)松弛不全。我院自1996年起对 35例贲门失弛缓症患者进行了气囊扩张 ,术前常规进行食管测压 ,其中 17例进行Rigiflex气囊扩张后测压复查及随访。现将其食管动力改变情况分析如下。一、资料和方法1 分组 :(1)病例组 :共 35例贲门失弛缓症患者 ,男 2 0例 ,女 15例 ,平均年龄 (38± 2 7)岁 ,所有患者经内镜和食管钡餐确诊为贲门失弛缓症。 (2 )对照组 :共 30例 ,男 13例 ,女 17例 ,平均年龄 (39± 14 …     

肉毒碱注射治疗食管贲门失弛缓症

食管贲门失弛缓症 (achalasia)是一种原因不明的食管运动功能障碍性疾病，其主要特征是 :下食管括约肌 (LES)高压、食管缺乏蠕动和对吞咽动作的松弛反应障碍。临床表现为吞咽困难、食物反流以及下端胸骨后不适或疼痛，可伴有体重减轻等表现。本病的治疗主要是通过各种手段降低 LES压力。目前，括约肌切开术和气囊扩张被认为是标准的治疗方法，其不足是有可能并发胃食管反流、出血或食管穿孔；长效硝酸酯类、钙通道阻滞剂等药物尚难达到令人满意的临床效果。最近几年，一种新型的、有希望的治疗手段——食管下括约肌内注射肉毒碱应用于临…     

贲门失弛缓症的食管和食管外动力的研究

贲门失弛缓症的食管和食管外动力的研究蓝宇，柯美云１７世纪Ｔｈｏｍａｓｗｉｌｌｉｓ首次描述了贲门失弛缓症的食管动力异常。到目前为止，贲门失弛缓症的病因仍不十分清楚，但认为与食管壁内肌间神经丛（Ａｕｅｒｂａｃｈ’ｓ神经丛）的变性有关。有报告显示家族性的贲...     

贲门失弛缓症的内镜诊断探讨

经Ｘ线、食管测压和内镜确诊贲门失弛缓症５７例，突出症状为下咽困难、反流和胸痛。内镜主要表现为食管存有食物和液性滞留物、食管扩张、食管壁轮状收缩环、食管抻长和扭曲，还可见食管胃交接区紧闭，用内镜加压可以推开，反转观察贲门紧抱内镜轴。内镜检查不仅能对本病作出诊断，而且可以排除癌等其它器质性疾病和发现合并症。     

贲门失弛缓症的治疗进展

贲门失弛缓症是一种少见的食管运动障碍性疾病, 其病因及发病机制至今仍未确定. 目前本症的治疗多以缓解症状为主, 主要的治疗方法包括: 药物治疗、内镜下治疗及外科手术治疗. 本文就近年来贲门失弛缓症的治疗进展作一综述.     

A rational clinical approach to esophageal motor disorders

The diagnosis, classification, and treatment of esophageal motor disorders can be difficult and frustrating for both the clinician and patient. This review attempts to clarify and summarize our current understanding of esophageal motor disorders and presents a rational approach to their management. The opinions and assertions contained herein are those of the authors and are not to be construed as reflecting opinions of the United States Air Force or the Department of Defense     

贲门失弛缓症气囊扩张对食管动力近期和中期的影响

目的　探讨气囊扩张对贲门失弛缓症患者食管动力的影响及与扩张疗效的关系。方法　4 8例经临床、钡餐造影、内镜检查及食管测压确诊的贲门失弛缓症 ,采用上消化道动力监测系统。观察扩张前和扩张后 4周以及 12～ 2 4周时的症状计分、钡餐造影显示的食管最大宽度、下食管括约肌压力(LESP)、下食管括约肌松弛率 (LESRR)及食管体部收缩振幅。结果　①扩张后吞咽困难、胸痛和反食症状的计分以及食管的最大宽度均明显低于扩张前 (P <0 .0 5 )。②扩张后 4周、12～ 2 4周 4个方位的LESP明显降低 (P <0 .0 5 ) ,4个方位相应的LESRR扩张后较扩张前明显增加 (P <0 .0 5 )。③扩张前后LESP <2 .6 7kPa次数百分比分别为 4 5 .4 1% ,82 .4 8%和 85 .87% (与扩张前比P <0 .0 5 ) ,LESRR≥80 %的次数百分比分别占 6 .74 % ,5 5 .97%和 4 3.78% (与扩张前比P <0 .0 5 )。④ 4 8例患者中未发现食管体部恢复推进性蠕动波。食管体部收缩振幅扩张前 ,后均表现为无效收缩。结论　①气囊扩张治疗贲门失弛缓症近期、中期疗效较好 ,并有维持治疗作用。②气囊扩张不仅降低LESP且改善LESRR ,是气囊扩张缓解症状、减少食管扩张程度的重要病理生理改变的基础。提示是否再行扩张的食管动力指标除LESP外 ,还要考虑LESRR。     

经口内镜下肌切开术治疗贲门失弛缓症疗效分析

目的探讨经口内镜下肌切开术（POEM）治疗贲门失弛缓症的疗效及安全性。方法对40例贲门失弛缓症患者进行POEM治疗,手术前后评估症状及食管造影、食管测压、胃镜等检查,于术后第6天、1个月、3个月、6个月评估疗效,并观察手术并发症。结果40例贲门失弛缓症患者均顺利完成POEM,手术时间（57．2±18．4）min,术中有2例出现纵隔和皮下气肿。术后缓解率100％（Eekardt评分≤3分）,平均随访13．3个月,复发2例,半年缓解率90％。食管测压术前食管下括约肌平均静息压30．6mmHg（1mmHg=Q133kPa）,术后15．8mmHg（P=0.001）;术前平均综合松弛压28．1mmHg,术后12．2mmHg（P=0．000）;平均食管最宽径术前4．2cm,术后3．1cm（P〈0．001）。结论POEM治疗贲门失弛缓症安全、有效,短期疗效肯定,并发症少,长期疗效及远期并发症有待随访研究。     

Efficacy of peroral endoscopic myotomy vs other achalasia treatments in improving esophageal function

AIM: To assess and compare the esophageal function after peroral endoscopic myotomy(POEM) vs other conventional treatments in achalasia.METHODS: Chart review of all achalasia patients who underwent POEM, laparoscopic Heller myotomy(LHM) or pneumatic dilation(PD) at our institution between January 2012 and March 2015 was performed. Patient demographics, type of achalasia, prior treatments, pre- and post-treatment timed barium swallow(TBE) and high-resolution esophageal manometry(HREM) findings were compared between the three treatment groups. Patients who had both pre- and 2 mo posttreatment TBE or HREM were included in the final analysis. TBE parameters compared were barium column height, width and volume of barium remaining at 1 and 5 min. HREM parameters compared were basal lower esophageal sphincter(LES) pressures and LES-integrated relaxation pressures(IRP). Data are presented as mean ± SD, median [25th, 75 th percentiles] or frequency(percent). Analysis of variance, KruskalWallis test, Pearsons χ~2 test and Fishers Exact tests were used for analysis.RESULTS: A total of 200 achalasia patients were included of which 36 underwent POEM, 22 underwent PD and 142 underwent LHM. POEM patients were older(55.4 ± 16.8 years vs 46.5 ± 15.7 years, P = 0.013) and had higher BMI than LHM(29.1 ± 5.9 kg/m~2 vs 26 ± 5.1 kg/m~2, P = 0.012). More number of patients in POEM and PD groups had undergone prior treatments compared to LHM group(72.2% vs 68.2% vs 44.3% respectively, P = 0.003). At 2 mo post-treatment, all TBE parameters including barium column height, width and volume remaining at 1 and 5 min improved significantly in all three treatment groups(P = 0.01 to P 0.001) except the column height at 1 min in PD group(P = 0.11). At 2 mo post-treatment, there was significant improvement in basal LES pressure and LES-IRP in both LHM(40.5 mm Hg vs 14.5 mm Hg and 24 mm Hg vs 7.1 mm Hg respectively, P 0.001) and POEM groups(38.7 mm Hg vs 11.4 mm Hg and 23.6 mm Hg vs 6.6 mm Hg respectively, P 0.001). However, when the efficacy of three treatments were compared to each other in terms of improvement in TBE or HREM parameters at 2 mo, there was no significant difference(P 0.05).CONCLUSION: POEM, PD and LHM were all effective in improving esophageal function in achalasia at shortterm. There was no difference in efficacy between the three treatments.     

暂时性金属支架扩张术治疗贲门失弛缓症对食管动力中远期的影响

目的:探讨暂时性金属支架治疗贲门失弛缓症对食管动力中远期的影响.方法:19例贲门失弛缓症患者在X线下置入国产可扩张带膜金属支架,术后3-7d由胃镜取出.治疗前、后2wk及2a测定LES静息压、松弛率、食管内24h pH监测,12例健康人测定下食管括约肌(LES)静息压、松弛率.结果:扩张后2wk和2a LES静息压显著低于扩张前LES静息压(12.32±5.87 mmHg,14.21±7.34 mmHg vs 47.43±9.84 mmHg,P<0.05),松弛率显著高于扩张前松弛率压(76.66%,73.46% vs 13.33%,P<0.05),但他们均与正常人无显著差异.扩张后2a GER阳性率显著高.于扩张后2wk及扩张前(66.12% vs 27.72%,2.95%;P<0.01).结论:中远期暂时性金属支架扩张术仍能显著降低贲门失弛缓症患者的LES压力.但GER也显著增加.     

Perendoscopic pneumatic dilatation in achalasia: Assessment of outcome using esophageal scintigraphy

Sixteen patients (nine male) underwent perendoscopic pneumatic dilatation for achalasia. The Witzel dilator was chosen as it allows placement of the balloon under endoscopic vision. Its efficacy was assessed using esophageal scintigraphy. Symptom score and esophageal transit values at 100 s and after a drink of water all improved significantly (P≤0.014) after dilatation and there was a significant correlation between the improved symptom score and the change in transit values after 100 s (r=0.586,P=0.017). At follow-up at 8 (3–16) months [mean (range)], 15 of 16 patients (94%) are symptom free. The Witzel dilator is effective in the treatment of achalasia. Esophageal scintigraphy offers a quantitative assessment of esophageal function, helping the clinical investigator evaluate new forms of therapy.     

Non-surgical treatment of esophageal achalasia

INTRODUCTION Esophageal achalasia is a rare neuromuscular disorder characterized by degenerative changes of myenteric plexus leading to a selective loss of inhibitory nerve endings. The consequences of this damage are the irreversible loss of peristaltic …     

食管测压在不典型贲门失弛缓症诊断中的应用

早期或不典型贲门失弛缓症临床诊断较难,X线钡餐检查敏感性较低.该病可能与食管动力障碍有关,食管测压对其诊断可能有较高的价值.目的:通过分析不典型贲门失弛缓症患者的食管测压参数,探讨其特征性表现,为早期诊断提供依据.方法:对21例不典型贲门失弛缓症、15例典型贲门失弛缓症和10名健康对照者进行食管压力测定.结果:不典型贲门失弛缓症组与典型贲门失弛缓症组的LES静息压类似,但均显著高于健康对照组(P＜0.01).健康对照组、不典型贲门失弛缓症组和典型贲门失弛缓症组的LES残余压呈递增趋势,且两两比较有显著差异(P＜0.01);不典型贲门失弛缓症组仅6例(28.6%)患者LES静息压增加,但有14例(67.7%)LES残余压增加.不典型贲门失弛缓症组50.2%的患者吞咽后LES可完全松弛,松弛率与典型贲门失弛缓症组比较无显著差异,但显著低于健康对照组(P＜0.01).食管体部收缩振幅在三组间无显著差异,多数失弛缓症患者湿咽后表现为无传导性同步收缩,与健康对照组比较有显著差异(P＜0.01).结论:不典型和典型贲门失弛缓症患者的LES静息压和LES松弛率均显著高于健康对照组,但用于诊断贲门失弛缓症敏感性较低.LES残余压对不典型贲门失弛缓症的诊断有较高的敏感性.吞咽后食管体部无传导性同步收缩是所有贲门失弛缓症患者的特征.     

Self-medication of achalasia with cannabis,complicated by a cannabis use disorder

Achalasia is a rare esophagus motility disorder. Medical, endoscopic and surgical treatments are available, but all endorse high relapse rates. No data has been published to date reporting a therapeutic effect of cannabis use neither in achalasia nor on its influence on manometric measurements. We report the case of a patient diagnosed with achalasia. He could benefit from a large panel of therapeutic interventions, but none of them was effective over the time. He first used cannabis at age 20 and identified benefits regarding achalasia symptoms. He maintained regular moderate cannabis use for 9 years, with minimal digestive inconvenience. A manometry performed without cannabis premedication was realized at age 26 and still found a cardiospasm. Cannabis use could explain the gap between functional symptoms assessment and manometry measurement. Further investigations are warranted to explore a therapeutic effect of cannabis in achalasia and possible influence on outcome measurements.