背景:食管胃结合部流出道梗阻(EGJOO)是贲门失弛缓症(AC)的变种还是某些器质性或全身性疾病的食管运动状态仍存在争议。我们旨在通过4年的随访研究EGJOO和AC在临床特征和结果方面的差异。
方法:纳入诊断为原发性EGJOO或AC的患者。基于伴随疾病的存在,EGJOO患者分为功能性和解剖学EGJOO组;类似地,将AC患者分为合并器质性疾病的AC组和真正的AC组。回顾性比较各组的疾病特征和高分辨率测压(HRM)参数,在随访期间检查了可能影响食管运动障碍和治疗反应的器质性疾病的发展。症状缓解定义为治疗后Eckardt评分≤3。
结果:该研究包括79例AC患者和70例EGJOO患者。与AC患者相比,EGJOO患者年龄较大,疾病持续时间较短,Eckardt得分较低,并且更可能并发食管胃结合部腺癌(AEG)和自身免疫性疾病(全部p<0.05)。解剖学EGJOO组吞咽困难的严重程度和Eckardt评分高于功能性EGJOO组。在人力资源管理参数(UES残余压力,LES基础压力,和LES残余压力)在AC和EGJOO患者之间。然而,功能性EGJOO组和解剖学EGJOO组之间的HRM参数没有显着差异。67例(95.71%)EGJOO患者和69例(87.34%)AC患者症状缓解(p=0.071)。在症状缓解的患者中,相对较大比例的EGJOO患者在药物治疗后症状缓解(37/67,55.22%),潜在原因的解决(7/67,10.45%),和自发缓解(15/67,22.39%),而更多的AC患者在POEM后症状缓解(66/69,95.65%)。在EGJOO患者中,症状得到缓解,在解决EGJOO的潜在原因后,更多的解剖EGJOO患者(7/20,35%)症状缓解,而更多的功能性EGJOO患者(32/47,68.09%)通过药物治疗症状缓解。
结论:并发AEG和自身免疫性疾病在EGJOO中比在AC中更可能。EGJOO的相当一部分可能是器质性疾病的早期表现。解剖EGJOO患者经历症状改善与原发疾病的解决,而大多数功能性EGJOO患者仅通过药物治疗甚至不进行任何治疗就可以缓解症状。
BACKGROUND: Whether esophagogastric junction outflow obstruction (EGJOO) is a variant of achalasia cardia (AC) or an esophageal motility state of certain organic or systemic diseases remains controversial. We aimed to investigate the differences between EGJOO and AC in clinical characteristics and outcomes through a 4-year follow-up.
METHODS: Patients diagnosed with primary EGJOO or AC were included. Based on the presence of concomitant disease, EGJOO patients were divided into a functional and an anatomical EGJOO group; similarly, patients with AC were divided into an AC with organic disease group and a true AC group. Disease characteristics and high-resolution manometry (HRM) parameters were retrospectively compared between the groups, and the development of organic diseases that could affect esophageal motility disorders and responses to treatment were examined during the follow-up. Symptom relief was defined as an Eckardt score of ≤3 after the treatment.
RESULTS: The study included 79 AC patients and 70 EGJOO patients. Compared with patients with AC, EGJOO patients were older, had shorter disease duration, a lower Eckardt score, and were more likely to have concurrent adenocarcinoma of the esophagogastric junction (AEG) and autoimmune disease (p < 0.05 for all). The severity of dysphagia and Eckardt scores were higher in the anatomical EGJOO group than in the functional EGJOO group. Significant differences were seen in HRM parameters (UES residual pressure, LES basal pressure, and LES residual pressure) between AC and EGJOO patients. However, no significant differences in HRM parameters were observed between the functional EGJOO and anatomical EGJOO groups. Sixty-seven (95.71%) patients with EGJOO and sixty-nine (87.34%) patients with AC experienced symptom relief (p = 0.071). Among patients achieving symptom relief, a relatively large proportion of patients with EGJOO had symptom relief after medications (37/67, 55.22%), the resolution of potential reasons (7/67, 10.45%), and spontaneous relief (15/67, 22.39%), while more patients with AC had symptom relief after POEM (66/69, 95.65%). Among EGJOO patients achieving symptom relief, more patients (7/20, 35%) with anatomical EGJOO had symptom relief after the resolution of potential reasons for EGJOO, while more patients (32/47, 68.09%) with functional EGJOO had symptom relief with medications.
CONCLUSIONS: Concurrent AEG and autoimmune diseases are more likely in EGJOO than in AC. A considerable part of EGJOO may be the early manifestation of an organic disease. Anatomical EGJOO patients experience symptom improvement with the resolution of primary diseases, while most functional EGJOO patients experience symptom relief with pharmacotherapy alone or even without any treatment.