[Comparison of clinical features and high-resolution esophageal motility characteristics between esophagogastric junction outflow obstruction and type Ⅱ achalasia patients].
OBJECTIVE
To compare the clinical features and high-resolution esophageal motility-impedance characteristics among esophagogastric junction outflow obstruction (Eoo) patients, type Ⅱ achalasia (Ach) patients and healthy controls (Con), in order to explore the values of esophageal high-resolution manometry (HRM) in diagnosis and treatment of Eoo patients.


METHODS
Patients with dysphagia were enrolled from December 2011 to December 2014 at the outpatient department of Peking University Third Hospital, so were age-matched healthy volunteers. All the patients with organic obstruction were excluded. All the participants were tested with high-resolution esophageal motility-impedance measurement, the patients were diagnosed as Eoo or Ach according to the Chicago classification criteria. Clinical features and esophageal motility characteristics of Eoo, Ach and Con were analyzed.


RESULTS
A total of 23 Eoo, 24 Ach and 20 Con were enrolled, whose gender ratios, average ages and body mass indexes were of no significant differences(all P>0.05). (1) The Eoo group had higher percentage of food reflux[21.7% (5/23) vs 0(0/24), P=0.005]and belching[17.4% (4/23) vs 0 (0/24), P=0.013], but lower percentage of dysphagia[47.8% (11/23) vs 79.2% (19/24), P=0.025]and vomiting[0(0/23) vs 12.5%(3/24), P=0.040]compared with the Ach group, with no significant differences in other symptoms(all P>0.05). Besides, the Eoo group had lower Eckardt scores than the Ach group[1(1, 2) vs 3 (2, 5), P<0.001]. (2) The lower esophageal sphincter (LES) basal pressure-minimum in the Eoo was higher than the Con[(26.73±2.77) vs (17.16±1.76) mmHg, P<0.05]. The mean LES basal pressure; and the LES integrated relaxation pressure (IRP), IRP-maximum, and LES relaxation percentage were significantly different among Eoo, Ach and Con[(19.80±1.25) vs (35.95±2.36), (8.43±0.72) mmHg, both P<0.05; (23.22±2.02) vs (48.37±3.71), (12.32±1.29) mmHg, bothP<0.05; 38.61%±3.10% vs 12.42%±5.66%, 64.00%±3.85%, both P<0.05]. (3) There were significant differences in velocity, amplitude, and duration of esophageal peristaltic wave and intrabolus pressure (all P<0.05) among Eoo, Ach and Con; and failed contraction percentage, panesophageal pressurization percentage, premature contraction percentage, and rapid contraction percentage of Eoo were lower than Ach (all P<0.05) while complete contraction percentage of Eoo was high compared with Ach (P<0.001), but no significant differences between Eoo and Con. (4) The Eoo had significantly less incomplete bolus clearance[0.00% (0.00%, 20.00%) vs 100.00% (90.00%, 100.00%), P<0.001]and shorter bolus transit time[(5.44±0.29) s vs (24.13±1.69) s, P<0.001]than Ach, but there were no significant differences between Eoo and Con in these two indexes[0.00% (0.00%, 20.00%) vs 0.00% (0.00%, 9.75%); (5.44±0.29) s vs (5.30±0.19) s; both P>0.05].


CONCLUSIONS
The clinical manifestations and esophageal HRM characteristics of Eoo appear to be between Ach and Con, which suggests that Eoo may be an early-stage of Ach. Further study of the pathophysiological characteristics of Eoo patients may provide more evidence to elucidate the pathogenesis of achalasia.
Department of Gastroenterology, Peking University Third Hospital, Beijing 100191, China.
Z J
ZJ
Liu
K
K
Wang
L P
LP
Duan
Z W
ZW
Xia
Z J
ZJ
Xu
Y
Y
Ge
W H
WH
Bao
D015992:Body Mass Index; D004884:Eructation; D004931:Esophageal Achalasia / Q000175:diagnosis* / Q000503:physiopathology*; D015154:Esophageal Motility Disorders / Q000175:diagnosis* / Q000503:physiopathology*; D004943:Esophagogastric Junction / Q000503:physiopathology*; D005764:Gastroesophageal Reflux; D006801:Humans; D008365:Manometry; D010045:Outpatients; D011312:Pressure; D014839:Vomiting