Predictors of Symptom Improvement and Recurrence in Patients with Achalasia Treated bY Pneumatic Balloon Dilation

Song, Chi Wook; Jeen, Yoon Tae; Um, Soon Ho; Kim, Chang Duck; Ryu, Ho Sang; Hyun, Jin Hae

Abstract

BACKGROUND/AIMS: Pneumatic balloon dilation(BD) is considered to be the first line of treatment in patients with achalasia. However there have been little reports about whether the parameters of esophageal manometry and scintigraphy predict the long-term results after BD. The aims of this study were to determine the relationship between changes in symptom improvetnent and esophageal motor function in response to BD.
METHODS
21 patients with primary achalasia treated by BD were included. We used a balloon dilator(Rigiflex, 3.0 cm in diameter) and dilated twice for 1 minute each at a pressure of 7-15 psi, at a 5 minute interval. A comprehensive assessment of their symptoms and esophageal manometry and scintigraphy was performed before, 1 month after wards and again 1 year after BD.
RESULTS
1) One year after BD, four people had recurrence of symptoms and the remaining 17 patients(81%) had been successfully treated. 2) There was no relationship between patients age, sex, duration of symptoms and the symptom improvement scores of a year later. 3) Significant correlation was detected between changes in the symptom score of a year later and parameters of esophageal motor function such as reduction of lower esophageal sphincter pressure, normalized reversed gastroesophageal pressure gradient, and different configuration of simultaneous contractions after BD.
CONCLUSIONS
We conclude that the changes in objective responses such as lower esophageal sphincter pressure, gastroesophageal pressure gradient and configuration of simultaneous contractions are reliable predictors of symptom irnprovernent and recurrence in patients with achalasia treated by BD.