Modern achalasia- a new perspective on a long-standing disease
EAES Academy. Marom G. 07/05/22; 363178; P223
Gad Marom
Contributions
Contributions
Abstract
Introduction:
Achalasia patients typically suffer from progressive dysphagia, vomiting and significant weight loss. The Eckardt score, used to evaluate the severity of the disease, is question based, and includes dysphagia occurrence and weight loss. However, in the last two decades the global obesity pandemic has changed the appearance of achalasia patients. Weight loss and dysphagia are no longer the hallmarks of the disease.
Our aim was to describe the new entity of modern achalasia and evaluate if overweight and obese patients have a different objective pre-operative evaluation as well as post-operative outcome.
Methods:
A retrospective study on a prospectively maintained database was performed on all patients treated for achalasia in our institution from 2012 to 2020. Pre-operative weight loss, pre- and post-operative IRP levels, length of stay (LOS), operative time and post-operative complications were studied.
Results:
One hundred twenty-six patients were included in the study. 77 patients (61%) had a BMI of 25 or less and consisted the normal weight group (NW). 49 patients (39%) were overweight and obese (OWAO group). The 2 groups had similar male to female ratio and type of achalasia. Both groups had a similar pre- and post-op IRP, operative time, LOS. However, the pre-op weight loss was considerably lower in the OWAO group, the pre-op Eckardt score was higher in the NW group than in the OWAO group as well as the its’ change post-op. in addition, the pre-op dysphagia was lower in the OWAO group than in the NW group.
Conclusions:
As high-resolution manometry becomes more available and improved awareness of clinicians of this rare disease, the incidence of achalasia diagnosis increases. Surgical myotomy is safe and gives equal clinical outcomes in the overweight and obese population. Typical appearance of cachexia and vomiting are no longer valid due to the obesity pandemic. Dysphagia and weight loss are less pronounced due to the accessibility of soft food and high protein shakes. evaluation of severity using the Eckardt score has limited value in today’s era. New objective measures for assessing the severity of achalasia are needed.
Achalasia patients typically suffer from progressive dysphagia, vomiting and significant weight loss. The Eckardt score, used to evaluate the severity of the disease, is question based, and includes dysphagia occurrence and weight loss. However, in the last two decades the global obesity pandemic has changed the appearance of achalasia patients. Weight loss and dysphagia are no longer the hallmarks of the disease.
Our aim was to describe the new entity of modern achalasia and evaluate if overweight and obese patients have a different objective pre-operative evaluation as well as post-operative outcome.
Methods:
A retrospective study on a prospectively maintained database was performed on all patients treated for achalasia in our institution from 2012 to 2020. Pre-operative weight loss, pre- and post-operative IRP levels, length of stay (LOS), operative time and post-operative complications were studied.
Results:
One hundred twenty-six patients were included in the study. 77 patients (61%) had a BMI of 25 or less and consisted the normal weight group (NW). 49 patients (39%) were overweight and obese (OWAO group). The 2 groups had similar male to female ratio and type of achalasia. Both groups had a similar pre- and post-op IRP, operative time, LOS. However, the pre-op weight loss was considerably lower in the OWAO group, the pre-op Eckardt score was higher in the NW group than in the OWAO group as well as the its’ change post-op. in addition, the pre-op dysphagia was lower in the OWAO group than in the NW group.
Conclusions:
As high-resolution manometry becomes more available and improved awareness of clinicians of this rare disease, the incidence of achalasia diagnosis increases. Surgical myotomy is safe and gives equal clinical outcomes in the overweight and obese population. Typical appearance of cachexia and vomiting are no longer valid due to the obesity pandemic. Dysphagia and weight loss are less pronounced due to the accessibility of soft food and high protein shakes. evaluation of severity using the Eckardt score has limited value in today’s era. New objective measures for assessing the severity of achalasia are needed.
Introduction:
Achalasia patients typically suffer from progressive dysphagia, vomiting and significant weight loss. The Eckardt score, used to evaluate the severity of the disease, is question based, and includes dysphagia occurrence and weight loss. However, in the last two decades the global obesity pandemic has changed the appearance of achalasia patients. Weight loss and dysphagia are no longer the hallmarks of the disease.
Our aim was to describe the new entity of modern achalasia and evaluate if overweight and obese patients have a different objective pre-operative evaluation as well as post-operative outcome.
Methods:
A retrospective study on a prospectively maintained database was performed on all patients treated for achalasia in our institution from 2012 to 2020. Pre-operative weight loss, pre- and post-operative IRP levels, length of stay (LOS), operative time and post-operative complications were studied.
Results:
One hundred twenty-six patients were included in the study. 77 patients (61%) had a BMI of 25 or less and consisted the normal weight group (NW). 49 patients (39%) were overweight and obese (OWAO group). The 2 groups had similar male to female ratio and type of achalasia. Both groups had a similar pre- and post-op IRP, operative time, LOS. However, the pre-op weight loss was considerably lower in the OWAO group, the pre-op Eckardt score was higher in the NW group than in the OWAO group as well as the its’ change post-op. in addition, the pre-op dysphagia was lower in the OWAO group than in the NW group.
Conclusions:
As high-resolution manometry becomes more available and improved awareness of clinicians of this rare disease, the incidence of achalasia diagnosis increases. Surgical myotomy is safe and gives equal clinical outcomes in the overweight and obese population. Typical appearance of cachexia and vomiting are no longer valid due to the obesity pandemic. Dysphagia and weight loss are less pronounced due to the accessibility of soft food and high protein shakes. evaluation of severity using the Eckardt score has limited value in today’s era. New objective measures for assessing the severity of achalasia are needed.
Achalasia patients typically suffer from progressive dysphagia, vomiting and significant weight loss. The Eckardt score, used to evaluate the severity of the disease, is question based, and includes dysphagia occurrence and weight loss. However, in the last two decades the global obesity pandemic has changed the appearance of achalasia patients. Weight loss and dysphagia are no longer the hallmarks of the disease.
Our aim was to describe the new entity of modern achalasia and evaluate if overweight and obese patients have a different objective pre-operative evaluation as well as post-operative outcome.
Methods:
A retrospective study on a prospectively maintained database was performed on all patients treated for achalasia in our institution from 2012 to 2020. Pre-operative weight loss, pre- and post-operative IRP levels, length of stay (LOS), operative time and post-operative complications were studied.
Results:
One hundred twenty-six patients were included in the study. 77 patients (61%) had a BMI of 25 or less and consisted the normal weight group (NW). 49 patients (39%) were overweight and obese (OWAO group). The 2 groups had similar male to female ratio and type of achalasia. Both groups had a similar pre- and post-op IRP, operative time, LOS. However, the pre-op weight loss was considerably lower in the OWAO group, the pre-op Eckardt score was higher in the NW group than in the OWAO group as well as the its’ change post-op. in addition, the pre-op dysphagia was lower in the OWAO group than in the NW group.
Conclusions:
As high-resolution manometry becomes more available and improved awareness of clinicians of this rare disease, the incidence of achalasia diagnosis increases. Surgical myotomy is safe and gives equal clinical outcomes in the overweight and obese population. Typical appearance of cachexia and vomiting are no longer valid due to the obesity pandemic. Dysphagia and weight loss are less pronounced due to the accessibility of soft food and high protein shakes. evaluation of severity using the Eckardt score has limited value in today’s era. New objective measures for assessing the severity of achalasia are needed.
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