Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 26, 2020; 8(4): 723-735
Published online Feb 26, 2020. doi: 10.12998/wjcc.v8.i4.723
Upper esophageal sphincter abnormalities on high-resolution esophageal manometry and treatment response of type II achalasia
Can-Ze Huang, Zai-Wei Huang, Hua-Min Liang, Zhen-Jiang Wang, Ting-Ting Guo, Yu-Ping Chen
Can-Ze Huang, Zai-Wei Huang, Hua-Min Liang, Zhen-Jiang Wang, Ting-Ting Guo, Yu-Ping Chen, Department of Gastroenterology, Zhuhai People’s Hospital (Zhuhai Hospital Affiliated with Jinan University), Zhuhai 519000, Guangdong Province, China
Author contributions: Huang CZ and Huang ZW are co-first authors and they contributed equally to this study. Huang CZ and Chen YP designed, organized, and mediated the present study and supervised the writing of the manuscript; Huang CZ and Huang ZW analyzed the data and wrote the manuscript; Liang HM, Wang ZJ, and Guo TT collected the cases and analyzed the data.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of Zhuhai People’s Hospital (Zhuhai Hospital Affiliated with Jinan University).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Yu-Ping Chen, Director, Department of Gastroenterology, Zhuhai People’s Hospital (Zhuhai Hospital Affiliated with Jinan University), 79 Kangning Road, Zhuhai 519000, Guangdong Province, China. yuping_chenzhh@163.com
Received: November 22, 2019
Peer-review started: November 22, 2019
First decision: December 23, 2019
Revised: December 26, 2019
Accepted: January 19, 2020
Article in press: January 19, 2020
Published online: February 26, 2020
Processing time: 96 Days and 6.9 Hours
Abstract
BACKGROUND

Little is known about the clinical significance of upper esophageal sphincter (UES) motility disorders and their association with the treatment response of type II achalasia. None of the three versions of the Chicago Classification of Esophageal Motility Disorders has defined UES abnormality metrics or their function. UES abnormalities exist in some patients and indicate a clinically significant problem in patients with achalasia.

AIM

To demonstrate the manometric differentiation on high-resolution esophageal manometry between subjects with abnormal UES and normal UES, and the association between UES type and the treatment response of type II achalasia.

METHODS

In total, 498 consecutive patients referred for high-resolution esophageal manometry were analyzed retrospectively. The patients were divided into two groups, those with normal and abnormal UES function. UES parameters were analyzed after determining lower esophageal sphincter (LES) function. Patients with type II achalasia underwent pneumatic dilation for treatment. Using mixed model analyses, correlations between abnormal UES and treatment response were calculated among subjects with type II achalasia.

RESULTS

Of the 498 consecutive patients, 246 (49.40%) were found to have UES abnormalities. Impaired relaxation alone was the most common UES abnormality (52.85%, n = 130). The incidence rate of type II achalasia was significantly higher in subjects with abnormal UES than those with normal UES (9.77% vs 2.58%, P = 0.01). After pneumatic dilation, LES resting pressure, LES integrated relaxation pressure, and UES residual pressure were significantly decreased (41.91 ± 9.20 vs 26.18 ± 13.08, 38.94 ± 10.28 vs 16.71 ± 5.65, and 11.18 ± 7.93 vs 5.35 ± 4.77, respectively, P < 0.05). According to the Eckardt score, subjects with type II achalasia and abnormal UES presented a significantly poorer treatment response than those with normal UES (83.33% vs 0.00%, P < 0.05).

CONCLUSION

Impaired relaxation alone is the most common UES abnormality. The incidence of type II achalasia is associated with abnormal UES. Type II achalasia with abnormal UES has a poorer treatment response, which is a potentially prognostic indicator of treatment for this disease.

Keywords: Upper esophageal sphincter; High-resolution esophageal manometry; Achalasia; Treatment response

Core tip: In this retrospective study involving 498 consecutive patients who underwent high-resolution esophageal manometry, we found that impaired relaxation alone was the most common upper esophageal sphincter (UES) abnormality. The incidence rate of type II achalasia was significantly higher in subjects with abnormal UES than in those with normal UES. Subjects with type II achalasia and abnormal UES presented a significantly poorer treatment response than those with normal UES.