La manométrie œsophagienne est-elle incontournable dans la prise en charge de l’achalasie ?
Is esophageal manometry indispensable in the management of achalasia ?
Aims of study:To answer to a certain number of questions:
Two essential aims:
What is the contribution of manometry in the early diagnosis of achalasia?
Its impact on therapeutic procedure orientation?
And two accessory objectives:
What is the frequency of the achalasia at patients explored with esophageal manometry?
Do these patients have specific characters?
Material and method: Retrospective study of 388 cases with achalasia suspicion, on 1,434 manometry examination performed in the Functional digestive explorations department, at University hospital “Ibn Sina” of Rabat in Morocco, on a period of 10 years between January 1990 to December 2000. Only 184 cases have been kept in the clinical study, according to our inclusion criteria.
Material and technique of esophageal manometry used were compliant to the methodological rules recommended by the French National Agency of Health Accreditation and Evaluation (ANAES). The statistical analysis has been made with the help of a software SPSS.
Results:Prevalence of the achalasia in our study was 12,8 %. Dysphagia was the main symptom found in 97,3 % of cases. The mean delay between apparition of clinical signs and manométrie diagnosis was 38,2 ± 4 months.
The diagnosis of achalasia was made at an early stage of vigorous or hyper kinetic achalasia in 40,2 % of patients, and at a stage of hypokinetic achalasia in 59,8 % of cases.
Manometry diagnoses the major signs of the achalasia: relaxation of the LES in response to an absent or incomplete swallowing in 96,7 % of cases, esophageal aperistalsis in 95,6 % of cases, and hypertonic LES as a minor sign, was found in 80,4 % of patients.
Sphincterian pressure was even normal in 60 % of patients in the group of vigorous or hyperkinetic achalasia (P = 0,02).
We did not note any manometric particularities bound to age or gender, neither did we note any significant difference between the frequency of clinical signs, and manometric data: the pressure of the LES, relaxation and the absence of peristalsis.
Conclusion:Esophageal manometry is indispensable for early diagnosis of achalasia, even if the other exams are normal. The forwardness of the diagnosis allows to improve the posttherapeutic functional results. The realization of the preoperative manometry orients the therapeutic act.
Naima AMRANI, I. SERRAJ, N. KANOUNI, M. NYA
achalasia, aperistalsis, dysphagia, esophageal manometry, megaoesophagus, Heller myotomy, LES tonus