Download PDF
CC BY-NC-ND 4.0 · Endosc Int Open 2022; 10(12): E1570-E1576
DOI: 10.1055/a-1968-7682
Original article

Quality of life in patients with achalasia: Associations with Eckardt score and objective treatment outcomes after peroral endoscopic myotomy

Helge Evensen
1   Department of Gastroenterology, Oslo University Hospital, Norway
2   Faculty of Medicine, University of Oslo, Norway
,
Marianne Jensen Hjermstad
3   Regional Advisory Unit for Palliative Care, Dept. of Oncology, Oslo University Hospital, Norway
4   European Palliative Care Research Centre (PRC), Dept. of Oncology, Oslo University Hospital, Norway
5   Institute of Clinical Medicine, University of Oslo, Norway
,
Milada Cvancarova
1   Department of Gastroenterology, Oslo University Hospital, Norway
6   Faculty of Health Sciences, Oslo Metropolitan University, Norway
,
Vendel Kristensen
1   Department of Gastroenterology, Oslo University Hospital, Norway
7   Unger-Vetlesen Institute, Lovisenberg Diaconal Hospital, Oslo, Norway
,
Lene Larssen
1   Department of Gastroenterology, Oslo University Hospital, Norway
,
Jorunn Skattum
8   Department of Abdominal Surgery, Innlandet Hospital Trust, Hamar, Norway
,
Truls Hauge
1   Department of Gastroenterology, Oslo University Hospital, Norway
2   Faculty of Medicine, University of Oslo, Norway
,
Olav Sandstad
1   Department of Gastroenterology, Oslo University Hospital, Norway
,
Asle W. Medhus
1   Department of Gastroenterology, Oslo University Hospital, Norway
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Background and study aims Knowledge on self-reported quality of life (QoL) in achalasia and QoL improvements after peroral endoscopic myotomy (POEM) is limited. Furthermore, the clinical role of QoL in achalasia follow-up has not been evaluated. The present study aimed to examine QoL in achalasia patients before and after POEM and assess associations between QoL, Eckardt score (ES) and objective results.

Patients and methods This was a single-center prospective study of treatment-naïve achalasia patients with 12-month follow-up after POEM including manometry, upper endoscopy, 24-hour pH registration, and timed barium esophagogram. QoL data were registered using European Organisation for Research and Treatment of Cancer core questionnaire (QLQ-C30) and esophageal module (QLQ-OES18). Comparison with a reference population was performed to assess impact of achalasia on QoL and effect of therapy. Mixed models for repeated measures were applied.

Results Fifty patients (26 females) with a median age of 47 years (18–76) were included. Before treatment, all QoL domains were significantly impaired compared with an age- and gender-adjusted reference population (P < 0.05). No significant QoL-differences were found after POEM, except for fatigue and nausea/vomiting. Clinically relevant QoL improvement was observed in ≥ 50 % of the patients in all QoL domains, except for physical and role functioning. QoL was significantly associated with ES (P < 0.05) but not with objective results.

Conclusions Achalasia is associated with severe QoL impairment. Following POEM, a significant and clinically relevant QoL improvement is observed. QoL is associated with ES, but not with objective results after POEM.

Supplementary material



Publication History

Received: 23 July 2022

Accepted after revision: 25 October 2022

Accepted Manuscript online:
27 October 2022

Article published online:
15 December 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Pandolfino JE, Gawron AJ. Achalasia: a systematic review. Jama 2015; 313: 1841-1852
    Google Scholar
  • 2 Evensen H, Småstuen MC, Schulz A. et al. One year comprehensive prospective follow-up of achalasia patients after peroral endoscopic myotomy. Ann Med 2021; 53: 2225-2233
    CrossrefPubMedGoogle Scholar
  • 3 Eckardt VF, Aignherr C, Bernhard G. Predictors of outcome in patients with achalasia treated by pneumatic dilation. Gastroenterology 1992; 103: 1732-1738
    CrossrefPubMedGoogle Scholar
  • 4 Kostic SV, Rice TW, Baker ME. et al. Timed barium esophagogram: A simple physiologic assessment for achalasia. J Thoracic Cardiovasc Surgery 2000; 120: 935-943
    CrossrefPubMedGoogle Scholar
  • 5 Vaezi MF, Baker ME, Achkar E. et al. Timed barium oesophagram: better predictor of long term success after pneumatic dilation in achalasia than symptom assessment. Gut 2002; 50: 765-770
    Google Scholar
  • 6 Harnish JL, Darling GE, Diamant NE. et al. Patient-centered measures for achalasia. Surg Endosc 2008; 22: 1290-1293
    CrossrefPubMedGoogle Scholar
  • 7 Perbtani YB, Mramba LK, Yang D. et al. Life after per-oral endoscopic myotomy: long-term outcomes of quality of life and their association with Eckardt scores. Gastrointest Endosc 2018; 87: 1415-1420.e1
    CrossrefPubMedGoogle Scholar
  • 8 Vigneswaran Y, Tanaka R, Gitelis M. et al. Quality of life assessment after peroral endoscopic myotomy. Surg Endosc 2015; 29: 1198-1202
    CrossrefPubMedGoogle Scholar
  • 9 Ben-Meir A, Urbach DR, Khajanchee YS. et al. Quality of life before and after laparoscopic Heller myotomy for achalasia. Am J Surgery 2001; 181: 471-474
    CrossrefPubMedGoogle Scholar
  • 10 Frankhuisen R, van Herwaarden MA, Heijkoop R. et al. Persisting symptoms and decreased health-related quality-of-life in a cross-sectional study of treated achalasia patients. Aliment Pharmacol Therap 2007; 26: 899-904
    CrossrefPubMedGoogle Scholar
  • 11 Garrigues V, Ortiz V, Casanova C. et al. Disease-specific health-related quality of life in patients with esophageal achalasia before and after therapy. Neurogastroenterol 2010; 22: 739-745
    CrossrefPubMedGoogle Scholar
  • 12 Shemmeri E, Aye RW, Farivar AS. et al. Use of a report card to evaluate outcomes of achalasia surgery: beyond the Eckardt score. Surg Endosc 2019; 34: 1856-1862
    CrossrefPubMedGoogle Scholar
  • 13 Slone S, Kumar A, Jacobs J. et al. Accuracy of Achalasia Quality of Life and Eckardt scores for assessment of clinical improvement post treatment for achalasia. Dis Esophagus 2021; 34: doaa080
    CrossrefPubMedGoogle Scholar
  • 14 Hernandez Mondragon OV, Gonzalez Martinez MA. et al. Long-term quality of life after peroral endoscopic myotomy remains compromised in patients with achalasia type III. Endoscopy 2017; 49: 1209-1218
    Article in Thieme ConnectPubMedGoogle Scholar
  • 15 Kahrilas PJ, Bredenoord AJ, Fox M. et al. The Chicago Classification of esophageal motility disorders, v3.0. Neurogastroenterol Motility 2015; 27: 160-174
    CrossrefPubMedGoogle Scholar
  • 16 Neyaz Z, Gupta M, Ghoshal UC. How to perform and interpret timed barium esophagogram. J Neurogastroenterol Motility 2013; 19: 251-256
    CrossrefPubMedGoogle Scholar
  • 17 American Society of Anesthesiologists. ASA Physical Status Classification System. https://www.asahq.org/standards-and-guidelines/asa-physical-status-classification-system
    PubMedGoogle Scholar
  • 18 Aaronson NK, Ahmedzai S, Bergman B. et al. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 1993; 85: 365-376
    CrossrefPubMedGoogle Scholar
  • 19 Blazeby JM, Conroy T, Hammerlid E. et al. Clinical and psychometric validation of an EORTC questionnaire module, the EORTC QLQ-OES18, to assess quality of life in patients with oesophageal cancer. Europ J Cancer 2003; 39: 1384-1394
    CrossrefPubMedGoogle Scholar
  • 20 Hjermstad MJ, Fayers PM, Bjordal K. et al. Health-related quality of life in the general Norwegian population assessed by the European Organization for Research and Treatment of Cancer Core Quality-of-Life Questionnaire: the QLQ=C30 (+ 3). J Clin Oncol 1998; 16: 1188-1196
    CrossrefPubMedGoogle Scholar
  • 21 Kumagai K, Tsai JA, Thorell A. et al. Per-oral endoscopic myotomy for achalasia. Are results comparable to laparoscopic Heller myotomy?. Scand J Gastroenterol 2015; 50: 505-512
    CrossrefPubMedGoogle Scholar
  • 22 Kachala SS, Rice TW, Baker ME. et al. Value of routine timed barium esophagram follow-up in achalasia after myotomy. J Thoracic Cardiovasc Surg 2018; 156: 871-7.e2
    CrossrefPubMedGoogle Scholar
  • 23 Gyawali CP, Kahrilas PJ, Savarino E. et al. Modern diagnosis of GERD: the Lyon Consensus. Gut 2018; 67: 1351-1362
    CrossrefPubMedGoogle Scholar
  • 24 Armstrong D, Bennett JR, Blum AL. et al. The endoscopic assessment of esophagitis: a progress report on observer agreement. Gastroenterology 1996; 111: 85-92
    CrossrefPubMedGoogle Scholar
  • 25 Patel KS, Calixte R, Modayil RJ. et al. The light at the end of the tunnel: a single-operator learning curve analysis for per oral endoscopic myotomy. Gastrointest Endosc 2015; 81: 1181-1187
    CrossrefPubMedGoogle Scholar
  • 26 Silverman BW. Density Estimation for Statistics and Data Analysis. London: Chapman & Hall; 1986
    Google Scholar
  • 27 Chrystoja CC, Darling GE, Diamant NE. et al. Achalasia-specific quality of life after pneumatic dilation or laparoscopic heller myotomy with partial fundoplication: a multicenter, randomized clinical trial. Am J Gastroenterol 2016; 111: 1536-1545
    CrossrefPubMedGoogle Scholar
  • 28 Foisy H, Pioche M, Chabrun E. et al. Role of rapid drink challenge during esophageal high-resolution manometry in predicting outcome of peroral endoscopic myotomy in patients with achalasia. J Neurogastroenterol Motility 2020; 26: 204-214
    CrossrefPubMedGoogle Scholar
  • 29 Werner YB, Costamagna G, Swanstrom LL. et al. Clinical response to peroral endoscopic myotomy in patients with idiopathic achalasia at a minimum follow-up of 2 years. Gut 2016; 65: 899-906
    CrossrefPubMedGoogle Scholar
  • 30 Fosså SD, Hess SL, Dahl AA. et al. Stability of health-related quality of life in the Norwegian general population and impact of chronic morbidity in individuals with and without a cancer diagnosis. Acta Oncol 2007; 46: 452-461
    CrossrefPubMedGoogle Scholar
  • 31 Larssen L, Hauge T, Medhus AW. Stent treatment of malignant gastric outlet obstruction: the effect on rate of gastric emptying, symptoms, and survival. Surg Endosc 2012; 26: 2955-2960
    CrossrefPubMedGoogle Scholar
  • 32 Urbach DR, Tomlinson GA, Harnish JL. et al. A measure of disease-specific health-related quality of life for achalasia. Am J Gastroenterol 2005; 100: 1668-1676
    CrossrefPubMedGoogle Scholar