Relationships between endosonographic appearance and clinical or manometric features in patients with achalasia

被引:18
作者
Barthet, M [1 ]
Mambrini, P [1 ]
Audibert, P [1 ]
Boustiere, C [1 ]
Helbert, T [1 ]
Bertolino, JG [1 ]
Peyrot, J [1 ]
Salducci, J [1 ]
Grimaud, JC [1 ]
机构
[1] Hop Nord, Serv Hepatogastroenterol, F-13915 Marseille 20, France
关键词
achalasia; endoscopic ultrasonography; manometry; pneumatic dilatation; pseudoachalasia;
D O I
10.1097/00042737-199807000-00006
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Background The existence of endosonographic abnormalities of the oesophagus in achalasia is; discussed. The place of endoscopic ultrasonography (EUS) needs to be clarified. Patients Thirty five untreated patients suffering from achalasia and 28 controls without oesophageal disease were prospectively enrolled since 1993. Pseudoachalasia was diagnosed in two patients. Methods EUS measurements were performed at two opposite sites at the level of the cardia, and 5 cm and 10 cm proximally, avoiding compression by the water filled balloon. Results The oesophageal wall and the fourth hypoechoic layer were significantly thicker at the level of the cardia and 5 cm above, with mean differences between patients and controls of 0.37/0.42 mm and 0.16/0.23 mm respectively. No statistically significant correlation could be demonstrated between the thickness of the oesophageal wall or of the fourth hypoechoic layer and weight loss, or the average pressure of the lower oesophageal sphincter. However, a significant inverse relationship was demonstrated between the duration of symptoms and the thickness of the fourth hypoechoic layer. The thickness of the fourth hypoechoic layer was also increased in patients who required only one pneumatic dilatation (P < 0.01). Conclusion The thickness of the oesophageal wall and of the fourth hypoechoic layer appeared to be significantly increased in achalasia patients. However, the slight increase of the mean size (< 0.5 mm) of the muscularis propria suggests that EUS is not helpful in the diagnosis of achalasia. The physiopathological basis of advanced achalasia has to be reconsidered as we demonstrated an inverse relationship between the duration of symptoms and the thickness of the muscularis propria. (C) 1998 Lippincott-Raven Publishers.
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页码:559 / 564
页数:6
相关论文
共 24 条
[1]   A FUNDAMENTAL-STUDY OF NORMAL LAYER STRUCTURE OF THE GASTROINTESTINAL WALL VISUALIZED BY ENDOSCOPIC ULTRASONOGRAPHY [J].
AIBE, T ;
FUJI, T ;
OKITA, K ;
TAKEMOTO, T .
SCANDINAVIAN JOURNAL OF GASTROENTEROLOGY, 1986, 21 :6-15
[2]  
CASSELLA RR, 1965, AM J PATHOL, V46, P279
[3]   ACHALASIA OF ESOPHAGUS - PATHOLOGIC + ETIOLOGIC CONSIDERATIONS [J].
CASSELLA, RR ;
SAYRE, GP ;
BROWN, AL ;
ELLIS, FH .
ANNALS OF SURGERY, 1964, 160 (03) :474-&
[4]   IDIOPATHIC MUSCULAR HYPERTROPHY OF ESOPHAGUS - POSTMORTEM INCIDENTAL FINDING IN 6 CASES AND REVIEW OF LITERATURE [J].
DEMIAN, SDE ;
VARGASCORTES, F .
CHEST, 1978, 73 (01) :28-32
[5]   ENDOSCOPIC ULTRASONOGRAPHY IN ACHALASIA [J].
DEVIERE, J ;
DUNHAM, F ;
RICKAERT, F ;
BOURGEOIS, N ;
CREMER, M .
GASTROENTEROLOGY, 1989, 96 (04) :1210-1213
[6]   PREDICTORS OF OUTCOME IN PATIENTS WITH ACHALASIA TREATED BY PNEUMATIC DILATION [J].
ECKARDT, VF ;
AIGNHERR, C ;
BERNHARD, G .
GASTROENTEROLOGY, 1992, 103 (06) :1732-1738
[7]   ACHALASIA - A MORPHOLOGIC STUDY OF 42 RESECTED SPECIMENS [J].
GOLDBLUM, JR ;
WHYTE, RI ;
ORRINGER, MB ;
APPELMAN, HD .
AMERICAN JOURNAL OF SURGICAL PATHOLOGY, 1994, 18 (04) :327-337
[8]   DIFFUSE MUSCULAR HYPERTROPHY OF ESOPHAGUS [J].
IYER, SK ;
CHANDRASEKHARA, KL ;
SUTTON, A .
AMERICAN JOURNAL OF MEDICINE, 1986, 80 (05) :849-852
[9]  
KHARILAS PJ, 1987, AM J MED, V82, P439
[10]   NONSPECIFIC ESOPHAGEAL MOTOR DISORDER ASSOCIATED WITH THICKENED MUSCULARIS PROPRIA OF THE ESOPHAGUS [J].
KOJIMA, Y ;
IKEDA, M ;
NAKAMURA, T ;
FUJINO, MA .
GASTROENTEROLOGY, 1992, 103 (01) :333-335