Importance of Barium Swallow Test and Chest CT Scan for Correct Diagnosis of Achalasia in the Primary Care Setting
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- Ishii Tadashi
- Department of Surgery, Tohoku University Graduate School of Medicine Department of Education and Support for Regional Medicine, Tohoku University Hospital
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- Akaishi Tetsuya
- Department of Education and Support for Regional Medicine, Tohoku University Hospital
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- Abe Michiaki
- Department of Education and Support for Regional Medicine, Tohoku University Hospital
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- Takayama Shin
- Department of Education and Support for Regional Medicine, Tohoku University Hospital
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- Koseki Ken
- Department of Surgery, Tohoku University Graduate School of Medicine
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- Kamei Takashi
- Department of Surgery, Tohoku University Graduate School of Medicine
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- Nakano Toru
- Division of Gastroenterology and Hepatobiliary Pancreatic Surgery, Tohoku Medical and Pharmaceutical University
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抄録
<p>Esophageal achalasia is a disease characterized by the impaired esophageal peristalsis and non-relaxation of the lower esophageal sphincter muscle with unknown causes. Clinical manifestation of the disease is nonspecific (e.g., weight loss, vomiting, and persistent cough); namely, early diagnosis of the disease is often difficult. Delayed diagnosis of the disease is known to impair the patients’ quality of life. Identifying the diagnostic factors that could cause diagnostic delay is needed. In this study, we collected data from 38 patients with achalasia and searched for diagnostic factors associated with delayed diagnosis (i.e., ≥ 6 months from the first hospital visit to diagnosis). The enrolled patients, diagnosed with achalasia based on esophageal manometry findings, had undergone surgical myotomy. As a result, the diagnosis of achalasia was likely to be delayed when the physician who had first contacted the patient did not perform a barium swallow test (p < 0.0001) or chest CT scan (p < 0.01) in a timely fashion. Among the patients with a delayed diagnosis (n = 15), none underwent a barium swallow test or chest CT within 6 months from their first hospital visit. The estimated sensitivities of diagnostic examinations for achalasia based on the enrolled 38 patients were higher than 80% for the barium swallow test and chest CT scan, but only 50-81% for endoscopy. To avoid the delayed diagnosis of achalasia, performing a barium swallow test or chest CT scan in a timely fashion, in addition to routine endoscopy, appears to be highly important.</p>
収録刊行物
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- The Tohoku Journal of Experimental Medicine
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The Tohoku Journal of Experimental Medicine 247 (1), 41-49, 2019
東北ジャーナル刊行会