Correlation of esophageal clearance and dysphagia symptom assessment after treatment for achalasia.

Krieger-Grübel, Claudia; Tutuian, Radu; Borovicka, Jan (2016). Correlation of esophageal clearance and dysphagia symptom assessment after treatment for achalasia. United European Gastroenterology Journal, 4(1), pp. 55-61. Sage 10.1177/2050640615584732

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BACKGROUND Early relapse after treatment of achalasia occurs in 10-32 % of patients. The best method to follow up these patients is not known. Symptoms often do not correlate with esophageal clearance: some patients are oligosymptomatic despite persistent esophageal stasis/dilatation. AIM The aim was to compare two methods of measurement of esophageal clearance (impedance manometry with barium swallow) in achalasia patients following treatment. Symptom assessment (Eckardt score/detailed dysphagia questions) was correlated with objective measurements of esophageal stasis (barium swallow and impedance manometry) in achalasia patients following treatment. METHODS Post-treatment patients were followed up after median 38.4 months (median range 1-144 months). Symptoms were quantified using the Eckardt score and detailed dysphagia questions. Timed barium swallow quantified distal esophageal retention 0.5, 1, 3, and 5 minutes after oral contrast and impedance manometry assessed total and segmental esophageal clearance during water/viscous swallows and free drinking (200 mL). RESULTS Thirty-two patients (7 women, age 48.3; range 20-74) completed all investigations. Bolus retention in the distal esophagus assessed by impedance correlated well with barium swallow. There were no differences in impedance and timed barium swallow parameters between patients with Eckardt score 0-2 points or ≥3 points. Nine (28%) patients had an Eckardt score ≥3 points and 21 (66%) had ≥1 point in the detailed dysphagia questions. Patients without any dysphagia history had lower barium column height and width at 3 and 5 minutes compared to those with ≥1 positive answer in the detailed dysphagia questions. Correlation between the Eckardt score and detailed dysphagia questions was moderately good (r = 0.546; p = 0.001). CONCLUSION A detailed history of esophageal dysphagia rather than the Eckardt score is more sensitive to detect oligosymptomatic patients with disturbed esophageal clearance. Impedance manometry correlates well with the timed-barium swallow examination and represents an alternative objective assessment as it avoids radiation exposure.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Visceral Surgery and Medicine > Gastroenterology

UniBE Contributor:

Tutuian, Radu

Subjects:

600 Technology > 610 Medicine & health

ISSN:

2050-6406

Publisher:

Sage

Language:

English

Submitter:

Lilian Karin Smith-Wirth

Date Deposited:

03 May 2017 09:37

Last Modified:

03 May 2017 09:37

Publisher DOI:

10.1177/2050640615584732

PubMed ID:

26966523

Uncontrolled Keywords:

Achalasia; impedance manometry; questionnaire; symptom assessment; timed barium swallow

BORIS DOI:

10.7892/boris.94405

URI:

https://boris.unibe.ch/id/eprint/94405

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