Esophagogastric junction distensibility in the management of achalasia patients: relation to treatment outcome.
BACKGROUND
Achalasia is characterized by a functional esophagogastric junction (EGJ) obstruction. The functional luminal imaging probe (EndoFLIP) is a method to assess EGJ distensibility. In a homogeneous group of newly diagnosed achalasia patients treated with pneumatic dilation (PD), we aimed (i) to determine whether the assessment of EGJ distensibility has added value in the management of achalasia patients and (ii) to evaluate whether EGJ distensibility differs between achalasia subtypes.


METHODS
Twenty-six newly diagnosed achalasia patients were treated by graded PD (30 and 35 mm) separated by 1 week. EGJ distensibility was measured with the EndoFLIP technique before and after 30 mm PD. Good clinical outcome was defined as an Eckardt score <4 at 1-year follow-up. Fifteen healthy controls underwent an EndoFLIP measurement as control group.


RESULTS
Newly diagnosed achalasia patients had reduced EGJ distensibility compared to healthy controls (0.9 [0.7-1.5] vs 3.4 [2.7-4.2] mm(2) /mmHg, p < 0.01), and EGJ distensibility was lower in type II compared to type I patients (0.8 [0.7-1.1] vs 1.5 [0.9-1.9] mm(2) /mmHg, p = 0.02). EGJ distensibility was increased after PD from 0.9 (0.7-1.5) to 4.2 (3.0-5.7) mm(2) /mmHg (p < 0.001). No difference was found in EGJ distensibility directly after PD between patients with good and poor clinical outcome at 1-year follow-up.


CONCLUSIONS
Assessment of EGJ distensibility with the EndoFLIP technique is able to demonstrate the functional EGJ obstruction in newly diagnosed achalasia patients and EGJ distensibility differs between achalasia subtypes. Although PD improves EGJ distensibility, assessment of EGJ distensibility with a limited number of distension steps provides no additional information that is useful for clinical evaluation and management of achalasia patients.
Division of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands.|NUTRIM, School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands.
F G M
FG
Smeets
Division of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands.|NUTRIM, School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands.
A A M
AA
Masclee
Division of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands.|NUTRIM, School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands.
D
D
Keszthelyi
Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, The Netherlands.
E T T L
ET
Tjwa
Division of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands.|NUTRIM, School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands.
J M
JM
Conchillo
D000328:Adult; D019468:Disease Management; D004931:Esophageal Achalasia / Q000503:physiopathology / Q000628:therapy*; D004943:Esophagogastric Junction / Q000503:physiopathology*; D004945:Esophagoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D055815:Young Adult
EGJ distensibility; achalasia; esophagus; healthy controls; subtypes; treatment