2005 Abstracts: Prospective Assessment of Clinical, Radiographic, and Endoscopic Predictors for Achalasia
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Prospective Assessment of Clinical, Radiographic, and Endoscopic Predictors for Achalasia
Lorenzo Ferri, University of Toronto, Division of Thoracic Surgery, Toronto, Ontario, Canada; Linda Miller, University of Toronto, Toronto, Ontario; Gail Darling, University of Toronto, Toronto, Onatrio, Canada
Introduction: The definitive diagnosis of achalasia requires access to esophageal manometry (EM), however the limited availability of this procedure complicates the identification of patients. In order to assess predictors to aid in the diagnosis of achalasia, we compared the clinical, radiographic and endoscopic characteristics of achalasia patients (AP) to controls (C).
Methods: Patients referred to EM for an assessment of dysphagia from 2-11/04 were asked to participate. The Achalasia Symptom Questionnaire (ASQ), a structured 11-question survey (score:0–best,67–worst), was completed by all consenting patients. ASQ scores, esophago-gastro-duodenoscopy (EGD), upper GI contrast study (UGI), and manometric features were compared between patents with subsequently confirmed achalasia (AP) and those with peristalsis on EM (C-Controls). Data presented as mean ± SD; t-test or chi-square determined significance (* p<0.05). Results: Of 724 EM performed from 2-11/04, 62 patients were referred specifically to rule out achalasia.40 APs and 22 Cs were identified. There was no difference in age (49±16 AP:52±15 C), gender, or ethnicity. ASQ scores were higher in AP (39±13 vs 21±10)*. Achalasia was defined by complete absence of peristalsis. Mean LES tone was higher in AP (28.5±12 vs 18.5±9 mmHg)*, however LES % relaxation (60.2% vs 95%)* and esophageal contraction amplitude (28.8±18 vs 91.6± 48 mmHg)* were lower. EDG and UGI reports were available in 67% APs and 57% Cs. Predictors are presented in the table with + and – predictive values for a diagnosis of achalasia.| Achal. | Con | PPV | NPV | |
| Endoscopy | ||||
| dilated esoph. * | 76% | 18% | 89% | 64% |
| retained food * | 51% | 9% | 92% | 53% |
| "tight" LES * | 67% | 18% | 88% | 44% |
| UGI | ||||
| birds beak * | 73% | 13% | 93% | 42% |
| dilated esoph. * | 84% | 25% | 89% | 67% |
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