目的观察抗焦虑抑郁辅助治疗老年弥漫性食管痉挛(DES)的效果。方法 56例老年DES患者,随机分为A组和B组,各28例。A组给予钙拮抗药,B组联合给予抗焦虑抑郁制剂。对治疗前后两组患者心理状态、食管下部括约肌压力及消化道的症状进行评估。...目的观察抗焦虑抑郁辅助治疗老年弥漫性食管痉挛(DES)的效果。方法 56例老年DES患者,随机分为A组和B组,各28例。A组给予钙拮抗药,B组联合给予抗焦虑抑郁制剂。对治疗前后两组患者心理状态、食管下部括约肌压力及消化道的症状进行评估。结果 A组患者治疗2周及停药2周食管下括约肌(LES)压力和收缩幅值与治疗前比较,差异具有统计学意义(P<0.05);B组患者在治疗2周与停药2周LES压力和收缩幅值分别为(26.1±11.5)、(25.8±12.3);(91.2±45.2)、(87.6±40.7)mm Hg(1 mm Hg=0.133 k Pa)与治疗前(37.2±16.9);(137.1±69.2)mm Hg比较,差异具有统计学意义(P<0.05);两组治疗2周与停药2周LES压力和收缩幅值比较,差异具有统计学意义(P<0.05)。A组在治疗4周后总有效率为60.7%(17/28),停止给药2周后总有效率为35.7%(10/28);B组经过2周治疗相关症状即可缓解,治疗4周的有效率为85.7%(24/28),停药2周后有效率为85.7%(24/28);两组比较差异具有统计学意义(P<0.05)。结论联合应用抗焦虑抑郁药物治疗老年弥漫性食管痉挛疗效显著。展开更多
Diffuse esophageal spasm (DES) and achalasia share both clinical and manometric characteristics. Some reports support the notion of progression of DES to achalasia. However, there are currently no prospective data in ...Diffuse esophageal spasm (DES) and achalasia share both clinical and manometric characteristics. Some reports support the notion of progression of DES to achalasia. However, there are currently no prospective data in support of this theory. To assess prospectively the rate of manometric progression of DES to achalasia. Manometry tracings of DES patients diagnosed between 1992 and 2003 were independently reviewed blindly and agreed on by two esophageal experts. Patients with DES who agreed to undergo repeat esophageal manometry constituted the study cohort. Follow- up manometry tracings were evaluated blindly and independently by the same two interpreters to determine the rate of manometric progression to achalasia. Predictors of manometric progression were assessed. A total of 32 patients were diagnosed with DES between 1992- 2003. Twelve patients (9M/3F;median age 62 years) agreed to participate and underwent second manometry (mean ± SD follow- up of 4.8± 3.4 years). Achalasia was diagnosed on follow- up manometry in one patient (8% ), seven (58% ) patients continued to have DES, three (25% ) had normal motility, and one (8% ) had nutcracker esophagus. There were no predictors of progression to achalasia based on the initial manometry parameters. A subgroup of DES patients with initial low esophageal body amplitude developed increase in esophageal simultaneous contractions on follow- up similar to the patient who evolved to achalasia. Following were the results. 1) Progression from DES to achalasia is uncommon. 2)DES patients with low esophageal body amplitude may develop increased simultaneous contractions over time. 3) DES remains an elusive diagnosis clinically and manometrically.展开更多
文摘目的观察抗焦虑抑郁辅助治疗老年弥漫性食管痉挛(DES)的效果。方法 56例老年DES患者,随机分为A组和B组,各28例。A组给予钙拮抗药,B组联合给予抗焦虑抑郁制剂。对治疗前后两组患者心理状态、食管下部括约肌压力及消化道的症状进行评估。结果 A组患者治疗2周及停药2周食管下括约肌(LES)压力和收缩幅值与治疗前比较,差异具有统计学意义(P<0.05);B组患者在治疗2周与停药2周LES压力和收缩幅值分别为(26.1±11.5)、(25.8±12.3);(91.2±45.2)、(87.6±40.7)mm Hg(1 mm Hg=0.133 k Pa)与治疗前(37.2±16.9);(137.1±69.2)mm Hg比较,差异具有统计学意义(P<0.05);两组治疗2周与停药2周LES压力和收缩幅值比较,差异具有统计学意义(P<0.05)。A组在治疗4周后总有效率为60.7%(17/28),停止给药2周后总有效率为35.7%(10/28);B组经过2周治疗相关症状即可缓解,治疗4周的有效率为85.7%(24/28),停药2周后有效率为85.7%(24/28);两组比较差异具有统计学意义(P<0.05)。结论联合应用抗焦虑抑郁药物治疗老年弥漫性食管痉挛疗效显著。
文摘Diffuse esophageal spasm (DES) and achalasia share both clinical and manometric characteristics. Some reports support the notion of progression of DES to achalasia. However, there are currently no prospective data in support of this theory. To assess prospectively the rate of manometric progression of DES to achalasia. Manometry tracings of DES patients diagnosed between 1992 and 2003 were independently reviewed blindly and agreed on by two esophageal experts. Patients with DES who agreed to undergo repeat esophageal manometry constituted the study cohort. Follow- up manometry tracings were evaluated blindly and independently by the same two interpreters to determine the rate of manometric progression to achalasia. Predictors of manometric progression were assessed. A total of 32 patients were diagnosed with DES between 1992- 2003. Twelve patients (9M/3F;median age 62 years) agreed to participate and underwent second manometry (mean ± SD follow- up of 4.8± 3.4 years). Achalasia was diagnosed on follow- up manometry in one patient (8% ), seven (58% ) patients continued to have DES, three (25% ) had normal motility, and one (8% ) had nutcracker esophagus. There were no predictors of progression to achalasia based on the initial manometry parameters. A subgroup of DES patients with initial low esophageal body amplitude developed increase in esophageal simultaneous contractions on follow- up similar to the patient who evolved to achalasia. Following were the results. 1) Progression from DES to achalasia is uncommon. 2)DES patients with low esophageal body amplitude may develop increased simultaneous contractions over time. 3) DES remains an elusive diagnosis clinically and manometrically.
