Abstract
Background: A new high-resolution manometry (HRM) parameter, the integrated relaxation pressure (IRP), has been proposed for the assessment of esophageal-gastric junction (EGJ) relaxation. Our aim was to assess the effect of Heller myotomy on IRP in achalasia patients. Methods: We prospectively collected data on achalasia patients who underwent HRM between 2009–2014. Barium swallow was used to assess esophageal diameter and shape. Manometric diagnoses were performed by using the Chicago Classification v3. All patients with a confirmed diagnosis of achalasia were treated surgically with Heller Myotomy Results: One hundred thirty-nine consecutive achalasia patients (M:F = 72:67) represented the study population. All the patients had 100 % simultaneous waves but 11 had an IRP <15 mmHg. At median follow-up of 28 months, the median of IRP was significantly lower after surgery (27.4 [IQR 20.4–35] vs 7.1 [IQR 4.4–9.8]; p <0.001), and so were the lower esophageal sphincter (LES) resting pressure (27 [IQR 18–33] vs 6 [IQR 3–11]; p <0.001). At univariate analysis, IRP correlated with the gender, LES resting residual pressure, and dysphagia score. Conclusions: This is the first study to have examined the role of IRP in achalasia, and how it changes after surgical treatment. An increased preoperative IRP correlated directly with a more severe dysphagia. The IRP was restored to normal by Heller myotomy.
| Original language | English |
|---|---|
| Pages (from-to) | 125-131 |
| Number of pages | 7 |
| Journal | Journal of Gastrointestinal Surgery |
| Volume | 20 |
| Issue number | 1 |
| DOIs | |
| Publication status | Published - Jan 1 2016 |
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Keywords
- Achalasia
- Heller myotomy
- High-resolution manometry
- Integrated relaxation pressure
ASJC Scopus subject areas
- Surgery
- Gastroenterology
Cite this
The Impact of Heller Myotomy on Integrated Relaxation Pressure in Esophageal Achalasia. / Salvador, Renato; Savarino, Edoardo; Pesenti, Elisa; Spadotto, Lorenzo; Capovilla, Giovanni; Cavallin, Francesco; Galeazzi, Francesca; Nicoletti, Loredana; Merigliano, Stefano; Costantini, Mario.
In: Journal of Gastrointestinal Surgery, Vol. 20, No. 1, 01.01.2016, p. 125-131.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - The Impact of Heller Myotomy on Integrated Relaxation Pressure in Esophageal Achalasia
AU - Salvador, Renato
AU - Savarino, Edoardo
AU - Pesenti, Elisa
AU - Spadotto, Lorenzo
AU - Capovilla, Giovanni
AU - Cavallin, Francesco
AU - Galeazzi, Francesca
AU - Nicoletti, Loredana
AU - Merigliano, Stefano
AU - Costantini, Mario
PY - 2016/1/1
Y1 - 2016/1/1
N2 - Background: A new high-resolution manometry (HRM) parameter, the integrated relaxation pressure (IRP), has been proposed for the assessment of esophageal-gastric junction (EGJ) relaxation. Our aim was to assess the effect of Heller myotomy on IRP in achalasia patients. Methods: We prospectively collected data on achalasia patients who underwent HRM between 2009–2014. Barium swallow was used to assess esophageal diameter and shape. Manometric diagnoses were performed by using the Chicago Classification v3. All patients with a confirmed diagnosis of achalasia were treated surgically with Heller Myotomy Results: One hundred thirty-nine consecutive achalasia patients (M:F = 72:67) represented the study population. All the patients had 100 % simultaneous waves but 11 had an IRP <15 mmHg. At median follow-up of 28 months, the median of IRP was significantly lower after surgery (27.4 [IQR 20.4–35] vs 7.1 [IQR 4.4–9.8]; p <0.001), and so were the lower esophageal sphincter (LES) resting pressure (27 [IQR 18–33] vs 6 [IQR 3–11]; p <0.001). At univariate analysis, IRP correlated with the gender, LES resting residual pressure, and dysphagia score. Conclusions: This is the first study to have examined the role of IRP in achalasia, and how it changes after surgical treatment. An increased preoperative IRP correlated directly with a more severe dysphagia. The IRP was restored to normal by Heller myotomy.
AB - Background: A new high-resolution manometry (HRM) parameter, the integrated relaxation pressure (IRP), has been proposed for the assessment of esophageal-gastric junction (EGJ) relaxation. Our aim was to assess the effect of Heller myotomy on IRP in achalasia patients. Methods: We prospectively collected data on achalasia patients who underwent HRM between 2009–2014. Barium swallow was used to assess esophageal diameter and shape. Manometric diagnoses were performed by using the Chicago Classification v3. All patients with a confirmed diagnosis of achalasia were treated surgically with Heller Myotomy Results: One hundred thirty-nine consecutive achalasia patients (M:F = 72:67) represented the study population. All the patients had 100 % simultaneous waves but 11 had an IRP <15 mmHg. At median follow-up of 28 months, the median of IRP was significantly lower after surgery (27.4 [IQR 20.4–35] vs 7.1 [IQR 4.4–9.8]; p <0.001), and so were the lower esophageal sphincter (LES) resting pressure (27 [IQR 18–33] vs 6 [IQR 3–11]; p <0.001). At univariate analysis, IRP correlated with the gender, LES resting residual pressure, and dysphagia score. Conclusions: This is the first study to have examined the role of IRP in achalasia, and how it changes after surgical treatment. An increased preoperative IRP correlated directly with a more severe dysphagia. The IRP was restored to normal by Heller myotomy.
KW - Achalasia
KW - Heller myotomy
KW - High-resolution manometry
KW - Integrated relaxation pressure
UR - http://www.scopus.com/inward/record.url?scp=84952985051&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84952985051&partnerID=8YFLogxK
U2 - 10.1007/s11605-015-3006-x
DO - 10.1007/s11605-015-3006-x
M3 - Article
C2 - 26519153
AN - SCOPUS:84952985051
VL - 20
SP - 125
EP - 131
JO - Journal of Gastrointestinal Surgery
JF - Journal of Gastrointestinal Surgery
SN - 1091-255X
IS - 1
ER -