Clinico-radiological correlates of achalasia.
OBJECTIVE
To study the clinical and radiographic characteristics of achalasia in a cohort Jordanian patients and to investigate the presence of any clinico-radiological relationships.


METHODS
Thirty-five cases of recently diagnosed untreated achalasia patients were studied at Jordan University Hospital, Amman, Jordan during the period of January 1999 to December 2002. Measurements of maximum esophageal and gastroesophageal (GE) junction diameters, as radiographic features, were obtained from films. The clinical features included age; gender; nature; frequency and duration of typical and atypical symptoms; total number of symptoms; calculated typical symptoms score; and diagnostic delay. Pearson correlation coefficients were calculated between radiographic and clinical features, and among the radiographic features themselves. Using Spearman's correlation coefficients, the later analysis was repeated for patients with diagnostic delay of 2 years or less and patients with more than 2 years. All results were evaluated based on the 0.05 level of significance.


RESULTS
There were 35 consecutive achalasia patients enrolled in this study (20 females and 15 males) with a mean age of 42.3 +/- 15.6 years and diagnostic delay of 29 +/- 26 months. On average, each patient has presented 2 typical symptoms and 2 atypical symptoms. The mean typical symptoms score was almost 3 out of the full score of 6. The mean GE junction diameter was 2.4 mms and maximum esophageal diameter was 29 mms. Maximum esophageal diameter was significantly correlated with the number of typical, atypical and total symptoms as well as with the typical symptom score and diagnostic delay. Negative correlation was found between GE junction diameter and maximum esophageal diameter; but only statistically significant for patients with diagnostic delay of more than 2 years.


CONCLUSIONS
Statistically significant relationship exists between maximum esophageal diameter and all clinical variables. Negative correlation exists between maximum esophageal diameter and GE junction diameter; however, only significant for patients with a diagnostic delay more than 2 years. The possibility of achalasia is high in patients with longer diagnostic delay who demonstrate negative relationship between maximum esophageal diameter and GE junction diameter.
Tarawneh
Emad S
ES
Department of Diagnostic Radiology and Gastroenterology Unit, Jordan University, PO Box 13200, Amman 11942, Jordan. mstarawneh@hotmail.com
Mahafzah
Waleed S
WS
Haroun
Azmi A
AA
Hadidy
Azmy M
AM
Shennak
Mustafa M
MM
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D015331:Cohort Studies; D003937:Diagnosis, Differential; D004931:Esophageal Achalasia / Q000000981:diagnostic imaging*; D004943:Esophagogastric Junction / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D007597:Jordan; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011859:Radiography; D013223:Statistics as Topic