PDF(Pubmed)
Abstract：
Achalasia is a rare esophageal disorder characterized by abnormal esophageal motility and swallowing difficulties. Pain and/or spasms often persist or recur despite effective relief of the obstruction. A survey by UK charity \'Achalasia Action\' highlighted treatments for achalasia pain/spasms as a key research priority. In this patient-requested systematic review, we assessed the existing literature on pharmacological therapies for painful achalasia. A systematic review of the literature using Medline, Embase and Cochrane databases was performed to identify studies evaluating pharmacological therapies for achalasia. Methodological quality of included randomized controlled trials was assessed using the Cochrane Risk of Bias tool. In total, 70% (40/57) of survey respondents reported experiencing pain/spasms. A range of management strategies were reported. Thirteen studies were included in the review. Seven were randomized controlled trials. Most studies were >30 years old, had limited follow-up, and focussed on esophageal manometry as the key endpoint. Generally, studies found improvements in lower esophageal pressures with medications. Only one study evaluated pain/spasm specifically, precluding meta-analysis. Overall risk of bias was high. The achalasia patient survey identified that pain/spasms are common and difficult to treat. This patient-requested review identified a gap in the literature regarding pharmacological treatments for these symptoms. We provide an algorithm for investigating achalasia-related pain/spasms. Calcium channel blockers or nitrates may be helpful when esophageal obstruction and reflux have been excluded. We advocate for registry-based clinical trials to expand the evidence base for these patients.
摘要：
贲门失弛缓症是一种罕见的食管疾病，其特征是食管运动异常和吞咽困难。尽管有效缓解了梗阻，但疼痛和/或痉挛通常会持续或复发。英国慈善机构“失弛缓症行动”的一项调查强调了对失弛缓症疼痛/痉挛的治疗是一项关键的研究重点。在这个病人要求的系统评价中，我们评估了有关痛性门失弛缓症的药物治疗的现有文献。使用Medline对文献进行系统回顾，进行Embase和Cochrane数据库以确定评估贲门失弛缓症的药物治疗的研究。使用Cochrane偏差风险工具评估纳入的随机对照试验的方法学质量。总的来说,70%(40/57)的调查对象报告经历疼痛/痉挛。报告了一系列管理策略。该综述包括13项研究。7项为随机对照试验。大多数研究年龄>30岁，随访有限，以食管测压为关键终点。一般来说,研究发现药物治疗可改善下食管压力.只有一项研究专门评估了疼痛/痉挛，排除荟萃分析。总体偏倚风险较高。门失弛缓症患者调查发现，疼痛/痉挛是常见且难以治疗的。这项患者要求的审查发现了有关这些症状的药物治疗的文献中的空白。我们提供了一种用于调查与失弛缓相关的疼痛/痉挛的算法。当排除食管阻塞和反流时，钙通道阻滞剂或硝酸盐可能会有所帮助。我们提倡基于注册的临床试验，以扩大这些患者的证据基础。
