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Balloon dilation of the esophago‐gastric junction affects lower and upper esophageal sphincter function in achalasia
Author(s) -
Wauters L.,
Oudenhove L.,
Selleslagh M.,
Vanuytsel T.,
Boeckxstaens G.,
Tack J.,
Omari T.,
Rommel N.
Publication year - 2014
Publication title -
neurogastroenterology and motility
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.489
H-Index - 105
eISSN - 1365-2982
pISSN - 1350-1925
DOI - 10.1111/nmo.12228
Subject(s) - achalasia , esophageal sphincter , high resolution manometry , esophagogastric junction , medicine , balloon dilation , sphincter , dilation (metric space) , cardiology , balloon , gastroenterology , esophagus , anesthesia , surgery , reflux , mathematics , disease , combinatorics , adenocarcinoma , cancer
Background Pneumatic dilation of the lower esophageal sphincter ( LES ) in achalasia has an unappreciated effect on upper esophageal sphincter ( UES ) function. We studied UES pressure patterns at baseline and alterations in UES parameters resulting from therapy. Methods High‐resolution manometry ( HRM ) tracings from 50 achalasia patients, seen at a tertiary center between January 2009 and July 2011, were reviewed. Manometric parameters studied were (i) LES : resting pressure (restP), 4‐second integrated relaxation pressure ( IRP 4); (ii) UES : resting pressure (restP), minimal relaxation pressure ( MRP ), peak pressure ( PP ), relaxation interval ( RI ), intrabolus pressure ( IBP ), and deglutitive sphincter resistance ( DSR ). Mixed models analyses with LES and UES parameters as dependent variables and treatment stage as within‐subject independent variable of interest were used. Correlations between treatment‐induced changes in LES , UES , and esophageal body ( EB ) parameters were performed. Key Results Pre‐ and posttreatment HRM tracings were available from 50 patients (mean age 52.7 ± 18.6 years, 29 men). Upper esophageal sphincter parameters MRP (17.9 ± 1.2 vs 15.2 ± 0.9 mmHg; p = 0.02) and IBP (31.5 ± 1.5 vs 27.4 ± 1.2 mmHg; p = 0.009) were significantly reduced after initial balloon dilation and this effect was significant in type II achalasia (p = 0.002 and p = 0.0006). Peak pressure, RI , and DSR were not. The therapeutic effect on LES IRP 4 correlated significantly with the change in UES MRP , statistically mediated by the change in EB deglutitive pressure (p = 0.004 and p = 0.0002). Conclusions & Inferences We present the first HRM study demonstrating that pneumatic dilation of the LES affects intraesophageal and UES pressures in patients with achalasia.