In this study, researchers from Cleveland, Ohio, describe the results and complexity of treatment for achalasia patients.
All patients presented to a single esophagologist at a tertiary referral center.
The researchers performed a retrospective chart review of 232 achalasia patients treated between 1994 and 2002.
They evaluated symptoms, manometric and timed barium esophagram results, and treatments/outcome.
There were 184 previously untreated patients. Pneumatic dilatation was used in 111 of these cases.
The team found that symptoms and barium emptying improved in 86% and 54%, respectively. They also found that 17% of patients required subsequent Heller myotomy.
Heller myotomy was used in an additional 72 patients. In these patients, symptoms and barium emptying improved in 89% and 44%, respectively.
In a further 39 older patients, botulinum toxin was used. In these patients, symptom improvement lasted for a mean 6.2 months, with frequent need for repeated injection.
The team found that approximately 43% of these patients required additional treatment with a different modality. Esophagectomy was done in 3 patients.
There were 48 patients who had undergone prior surgery.
Pneumatic dilatation was used in 10 of these cases. This achieved symptom and barium emptying improvement in 67% and 11%, respectively.
A further 21 patients underwent repeat Heller myotomy. In these patients, 57% had symptom improvement and 38% improved emptying. Esophagectomy required in 8 patients.
Dr Marcelo Vela’s team concluded, “Successful management of achalasia can be complex and may require more than one treatment modality”.
“Pneumatic dilatation and Heller myotomy are presently the best treatments for untreated achalasia with similar efficacy but greater proton pump inhibitor use after surgery”.
“Both are less successful after prior Heller myotomy”.