Для цитирования: Ивашкин В.Т., Трухманов А.С., Годжелло Э.А., Маев И.В., Евсютина Ю.В., Лапина Т.Л., Сторонова О.А. Рекомендации Российской гастроэнтерологической ассоциации по диагностике и лечению ахалазии кардии и кардиоспазма. Рос журн гастроэнтерол гепатол колопроктол 2016;26(4):36-54
Clinical symptoms of disease: difficulty of passage of solid and liquid food through the esophagus, vomit- ing, in certain cases — chest pain; severe disease is accompanied by cough and weight loss. Differential diagnosis is carried out with cardioesophageal cancer, peptic stricture, esophageal webs and rings, neuro- genic anorexia and coronary heart disease in the cases with chest pain.
Barium meal study reveals dilation and deformity of the esophagus, coneshaped narrowing in the lower esopha- geal sphincter area, retention of barium contrast in the esophagus, absence of stomach gas bubble.
Endoscopy discloses dilation and deviation of esopha- geal lumen, presence of food remnants, liquids and mucus, uniform opening of cardia at air insufflation and capability of passage of endoscope into the stomach. «The gold standard» of investigation of patients with suspected achalasia is manometry.
Clinical guidelines for the first time in Russian literature presents the latest approaches to cardiac achalasia diagnosis by high resolution esophageal manometry with application of modern Chicago classification. This classification defines three types of cardiac achalasia, and its usage provides significant increase of treatment prognosis accuracy.
Clinical guidelines contain the detailed description of all up-to-date treatment methods for cardiac achalasia and cardiospasm (conservative, endoscopic, surgical) aimed to dilation of cardia and decrease of its pressure to improve of passage of food through area of gastro- esophageal junction. Disease prognosis at timely diag- nosis and treatment is favorable; remission rate for 10 years post-pneumocardiodilation ranges 75 to 90%. However patients require constant outpatient monitor- ing due to esophageal cancer risk (3 to 8% of cases). Conclusion. Clinical guidelines contain complete mod- ern information, essential for the practical doctor on diagnosis and treatment of cardiac achalasia and car- diospasm.
Key words: cardiac achalasia, cardiospasm, lower esophageal sphincter, high resolution manometry, megaesophagus, thoracic esophagus dyskinesia, chest pain, esophagitis, esophageal cancer, cardiodilation, cardiomyotomy, diagnosis, treatment.
For citation: Ivashkin V.T., Trukhmanov A.S., Godzhello E.A., Mayev I.V., Evsyutina Yu.V., Lapina T.L., Storonova O.A. Diagnostics and treatment of cardiac achalasia and cardio- spasm: guidelines of the Russian gastroenterological associa- tion. Ross z gastroenterol gepatol koloproktol 2016;26(4):36-54