Clinical symptomatology was evaluated with ES. ES has four parameters, dysphagia, regurgitation, retrosternal pain and weight loss, each one ranging from 0 to 3 points, with a maximum of 12 points. A normal Eckardt score is three points or less.
Upper endoscopy (UE) was performed after at least 12 h of fasting, although this interval is not usually enough for esophageal emptying, and esophageal-retained food or stasis is usually encountered. Sometimes, this content is erroneously interpreted as reflux, although a tightly closed cardia is passed with the endoscope. One of the signs that the endoscopist can see is the different color between esophageal stasis (saliva, some foamy liquid) and gastric content (frequently contaminated with yellow bile). The presence of esophagitis or associated gastritis was evaluated.
TBE was performed on the patients included in the study for diagnosis purposes. During the esophageal time, the following aspects were followed: esophageal stasis and the presence of EGJ stenosis, which are the defining elements for achalasia, the presence of tertiary contractions, dilatation of third degree—diameter of the esophagus greater than 6 cm (normal maximum diameter < 2 cm), height of the column of barium in the esophagus >5 cm after 1 min and >2 cm after 5 min [15 (link)].
Oesophageal manometry was performed using a pneumohydraulic, low-compliance, water infusion system (Mui Scientific, Mississauga, ON, Canada) with an eight-channel water-perfused catheter (Albyn Medical). The catheter was connected to eight external pressure transducers and the signal was processed using dedicated software (Phoenix V3-Albyn Medical). The following parameters were observed: LES relaxation during swallowing by measuring: LES length, LES basal pressure, LES resting baseline, LES relaxation, relaxation period, LES volume vector and esophageal motility by assessing wave amplitude >35 mmHg, and propagated waves. Based on the manometric criteria, the type of achalasia could be assessed: type I—absent peristalsis without abnormal pressure, type II—absent peristalsis with some normal pressure waves, and type III—absent peristalsis with distal esophageal spastic contractions.
Upper endoscopy (UE) was performed after at least 12 h of fasting, although this interval is not usually enough for esophageal emptying, and esophageal-retained food or stasis is usually encountered. Sometimes, this content is erroneously interpreted as reflux, although a tightly closed cardia is passed with the endoscope. One of the signs that the endoscopist can see is the different color between esophageal stasis (saliva, some foamy liquid) and gastric content (frequently contaminated with yellow bile). The presence of esophagitis or associated gastritis was evaluated.
TBE was performed on the patients included in the study for diagnosis purposes. During the esophageal time, the following aspects were followed: esophageal stasis and the presence of EGJ stenosis, which are the defining elements for achalasia, the presence of tertiary contractions, dilatation of third degree—diameter of the esophagus greater than 6 cm (normal maximum diameter < 2 cm), height of the column of barium in the esophagus >5 cm after 1 min and >2 cm after 5 min [15 (link)].
Oesophageal manometry was performed using a pneumohydraulic, low-compliance, water infusion system (Mui Scientific, Mississauga, ON, Canada) with an eight-channel water-perfused catheter (Albyn Medical). The catheter was connected to eight external pressure transducers and the signal was processed using dedicated software (Phoenix V3-Albyn Medical). The following parameters were observed: LES relaxation during swallowing by measuring: LES length, LES basal pressure, LES resting baseline, LES relaxation, relaxation period, LES volume vector and esophageal motility by assessing wave amplitude >35 mmHg, and propagated waves. Based on the manometric criteria, the type of achalasia could be assessed: type I—absent peristalsis without abnormal pressure, type II—absent peristalsis with some normal pressure waves, and type III—absent peristalsis with distal esophageal spastic contractions.
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