Therapeutic advances in gastroenterology · 2025
Real-life management of nonobstructive esophageal dysphagia: analysis of a prospective multicentric Portuguese cohort.
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Mendes Raquel R, Rodrigues José Pedro, Simão Inês, Lima Helena, Guedes Tiago, Barrias Sílvia, Costa Mara Sarmento, Souto Paulo, Silva João Carlos, Correia João, Morão Bárbara, Revés Joana, Leal Carina, Curto José Dias, Marinho Rui Tato, Mascarenhas Saraiva Miguel
Аннотация
BACKGROUND: Nonobstructive esophageal dysphagia (NOD) is a common benign condition that significantly impacts quality of life. Management requires a motility-focused approach and consideration for concomitant comorbidities such as gastroesophageal reflux, visceral hypersensitivity, and psychological factors. Currently, esophagogastric junction (EGJ) outflow disorders have the most studied and effective treatments. Data on patient-reported dysphagia and quality of life in this population, and their evolution over time and treatment, are scarce.
OBJECTIVE: This study aims to evaluate the real-world management and behavior of NOD, focusing on motility profiles and the implementation of specific treatments.
DESIGN: This is a multicenter prospective observational study that follows the management and evolution of NOD in a Portuguese cohort for 6 months, focusing on dysphagia and quality of life, to evaluate its clinical behavior.
METHODS: Dysphagia and quality of life were assessed in 195 patients using validated patient-reported questionnaires at baseline and follow-up.
RESULTS: From 195 patients, 61% (n = 119) were female, with a mean age of 61 (SD 15) years. According to Chicago classification 4.0, 32.3% (n = 63) had EGJ outflow disorders, 12.8% (n = 25) spastic disorders, 16.4% (n = 32) hypomotile disorders, 35.9% (n = 70) normal motility, and 2.6% (n = 5) were inconclusive. At baseline, the mean PROMIS Gastrointestinal Disrupted Swallowing (PDS) T-score, EQ-5D-3L, and Visual Analog Scale (VAS) scores were 61.7 (SD 7.4), 0.61 (SD 0.26), and 69 (SD 18), respectively. Overall, at 6 months, there were significant improvements in the Eckardt, PDS, and EQ-5D-3L scores, with no difference in VAS. In EGJ disorders, myotomy significantly improved all measurements. In the remaining subgroups, a favorable evolution of dysphagia was observed, without differences between treated and untreated patients.
CONCLUSION: NOD tends to follow a benign course. Apart from achalasia, which has the most defined treatments with documented benefits, decisions for the remaining motility profiles should follow a comprehensive and personalized approach.
OBJECTIVE: This study aims to evaluate the real-world management and behavior of NOD, focusing on motility profiles and the implementation of specific treatments.
DESIGN: This is a multicenter prospective observational study that follows the management and evolution of NOD in a Portuguese cohort for 6 months, focusing on dysphagia and quality of life, to evaluate its clinical behavior.
METHODS: Dysphagia and quality of life were assessed in 195 patients using validated patient-reported questionnaires at baseline and follow-up.
RESULTS: From 195 patients, 61% (n = 119) were female, with a mean age of 61 (SD 15) years. According to Chicago classification 4.0, 32.3% (n = 63) had EGJ outflow disorders, 12.8% (n = 25) spastic disorders, 16.4% (n = 32) hypomotile disorders, 35.9% (n = 70) normal motility, and 2.6% (n = 5) were inconclusive. At baseline, the mean PROMIS Gastrointestinal Disrupted Swallowing (PDS) T-score, EQ-5D-3L, and Visual Analog Scale (VAS) scores were 61.7 (SD 7.4), 0.61 (SD 0.26), and 69 (SD 18), respectively. Overall, at 6 months, there were significant improvements in the Eckardt, PDS, and EQ-5D-3L scores, with no difference in VAS. In EGJ disorders, myotomy significantly improved all measurements. In the remaining subgroups, a favorable evolution of dysphagia was observed, without differences between treated and untreated patients.
CONCLUSION: NOD tends to follow a benign course. Apart from achalasia, which has the most defined treatments with documented benefits, decisions for the remaining motility profiles should follow a comprehensive and personalized approach.