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 20 February 2018

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News

Follow-up after pneumatic dilation for achalasia cardia

December's issue of the American Journal of Gastroenterology finds that pulmonary dilation is an effective and safe treatment for achalasia cardia, however, male patients have poorer outcomes.

News image

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Though most patients with achalasia cardia (AC) respond to pneumatic dilation (PD), 1/3 experience recurrence.

Long-term follow-up studies on factors associated with various outcomes are scanty.

Dr Ghoshal and colleagues from India undertook a retrospective study, in which 126 patients (36.5 ± 14.6 yr, 76 male) with AC (diagnosed by esophagoscopy, barium esophagogram, and/or manometry) were followed up in person or through mail.

The researchers calculated the median dysphagia-free duration by KaplanMeier analysis.

The investigators determined factors associated with nonresponse and recurrence after PD using univariate and multivariate analyses.

Symptoms were dysphagia (126, 100%), chest pain (21, 17%), regurgitation (61, 48%), weight loss (33, 26%), and pulmonary symptoms (23, 18%); 5 of 126 (4%) had megaesophagus (7 cm).

Male gender, pulmonary symptoms, absence of chest pain, and failure to achieve a reduction in LES pressure >50% after pulmonary dilation were associated with poor outcome
American Journal of Gastroenterology

The researchers found that the mean lower esophageal sphincter (LES) pressure was 38.7 ± 16.8 mmHg.

The research team also noted that 115 of 126 (91%) patients responded to PD (90 (71%) to first session); 25 of these had recurrence of dysphagia after 15 ± 17 months.

Post-PD chest pain requiring hospitalization occurred in 21 of 126 (17%; one had an esophageal perforation).

In addition, the researchers found that post-PD LES pressure, which the team had assessed in 48 of 126 patients, had decreased by >50% from baseline in 14 of 29 responders, 0 of 11 nonresponders (p= 0.004, 2 test), and 5 of 8 relapsers.

The median dysphagia-free duration by KaplanMeier analysis was 60 months (SE 2.7, 95% CI 54.765.3).

The researchers carried out univariate analysis and found that male gender, pulmonary symptoms, absence of chest pain, and failure to achieve a reduction in LES pressure >50% after PD were associated with poor outcome.

However, the research team noted that age, grade of dysphagia, regurgitation, megaesophagus, and LES pressure before PD were not.

Male gender was associated with poor outcome by multivariate-analysis.

Dr Ghoshal concluded, "PD is an effective and safe treatment for AC. Post-PD LES pressure measurement may be helpful in assessing response."

"Male patients have poorer outcomes following PD."

American Journal of Gastroenterology; 2004: 99 (12): 2304
03 December 2004

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