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Pull-down Heller myotomy improves the clinical outcome of advanced sigmoid achalasia
(Springer Science and Business Media LLC, 2025)
Méndez-Hernández, Dulce Paola
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Moreno-Fuentes, Miguel
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Barron-Cervantes, Natalia Maria
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Stenner-Escalante, Andres
;
Morales-Herrera, Carlos Alejandro
Introduction: Esophagectomy was considered the first line for advanced sigmoid (aSg) achalasia (esophageal angulation < 90°), while laparoscopic Heller myotomy (LHM) has a lower percentage of success. The pull-down LHM (PD-LHM) technique has emerged as a promising and more effective rescue therapy to avoid esophagectomy for aSg achalasia. However, the long-term functional results of PD-LHM are inconclusive. Objective: To compare the outcome of aSg achalasia (< 90°) who underwent the PD-LHM technique with those of non-advanced (naSg) achalasia (≥ 90°) and LHM. Patients and methods: This ambispective nested cohort study evaluated 34 achalasia patients with megaesophagus divided into two groups: (a) aSg (< 90°; n = 20; 59%) PD-LHM treated, and (b) naSg (≥ 90°; n = 14; 41%) LHM treated. The assessments included esophageal angulation and symptom questionnaires. All patients were clinically and manometrically evaluated before and at 1- and 12-month post-surgery intervals. Clinical outcomes focused on achieving esophageal angulation ≥ 90° and an Eckardt score < 3. Results: 65% of patients were men, and 65% had achalasia type I. The mean esophageal angulation in aSg was 79.6 ± 8.8°, and in naSg was 116.3 ± 16.3°. aSg improved to 99.5 ± 15.2°, and 17/20 patients (85%) shifted to the naSg group. aSg significantly improved in Eckard symptom score at 1 month (1.2 ± 1.3) vs. preoperative score (8.9 ± 1.6). The three aSg patients who experienced PD-LHM failure were male, type I achalasia, had higher preoperative IRP and LES pressure, were older, and had longer disease duration vs. success. A good clinical and manometric outcome was obtained in 85% of aSg. Conclusion: Our findings suggest that PD-LHM is an effective treatment for aSg with a success rate of 85%. ©The authors ©Surgical Endoscopy ©Springer Science and Business Media LLC.
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Polymerized Type I Collagen Downregulates STAT-1 Phosphorylation Through Engagement with LAIR-1 in Circulating Monocytes, Avoiding Long COVID
(MDPI, 2025)
Olivares-Martínez, Elizabeth
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Hernández-Ramírez, Diego Francisco
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Núñez-Álvarez, Carlos Alberto
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Meza-Sánchez, David Eduardo
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Chapa, Mónica
The intramuscular administration of polymerized type I collagen (PTIC) for adult symptomatic COVID-19 outpatients downregulated hyperinflammation and improved symptoms. We inferred that LAIR1 is a potential receptor for PTIC. Thus, a binding assay and surface plasmon resonance binding assay were performed to estimate the affinity of the interaction between LAIR1 and PTIC. M1 macrophages derived from THP-1 cells were cultured with 2–10% PTIC for 24 h. Lysates from PTIC-treated THP-1 cells, macrophage-like cells (MLCs), M1, M1 + IFN-γ, and M1 + LPS were analyzed by Western blot for NF-κB (p65), p38, STAT1, and pSTAT1 (tyrosine701). Serum cytokine levels and monocyte LAIR1 expressions (Mo1 and Mo2) were analyzed by luminometry and flow cytometry in symptomatic COVID-19 outpatients on PTIC treatment. PTIC-bound LAIR1 had a similar affinity to collagen in M1 macrophages. It downregulated pSTAT1 in IFN-γ-induced M1. COVID-19 patients under PTIC treatment showed a significant decrease in Mo1 percentages and cytokines (IP-10/MIF/eotaxin/IL-8/IL-1RA/M-CSF) associated with STAT1 and an increase in the Mo2 subset. The inflammatory mediators and Mo1 downregulation were related to better oxygen saturation and decreased dyspnea, chest pain, cough, and chronic fatigue syndrome in the acute and long-term phase of infection. PTIC is an agonist of LAIR1 and downregulates STAT-1 phosphorylation. PTIC could be relevant for treating STAT1-mediated inflammatory diseases, including COVID-19 and long COVID. ©The authors ©MDPI.
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A Higher Manometric Esophageal Length to Height Ratio in Achalasia Explains the Lower Prevalence of Hiatal Hernia
(2023)
Coss-Adame, Enrique
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Furuzawa-Carballeda, Janette
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Valdovinos , Miguel A.
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Sánchez-Gómez, Josué
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Peralta-Figueroa, José
Background/aims: The evidence suggests that a shorter esophageal length (EL) in gastroesophageal reflux disease (GERD) patients is associated with the presence of hiatal hernia (HH). However, there are no reports of this association in patients with achalasia. The aim is to (1) determine the prevalence of hiatal hernia in achalasia patients, (2) compare achalasia EL with GERD patients and healthy volunteers (HV), (3) measure achalasia manometric esophageal length to height (MELH) ratio, and (4) determine if there are differences in symptoms between patients with and without hiatal hernia. Methods: This retrospective and cross-sectional study consist of 87 pre-surgical achalasia patients, 22 GERD patients, and 30 HV. High-resolution manometry (HRM), barium swallow, and upper endoscopy were performed to diagnose HH. The EL and MELH ratio were measured by HRM. Symptoms were assessed with Eckardt, Eating Assessment Tool, and GERD-health-related quality of life questionnaires.
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