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Comparison of Treatment Response in Different Types of Achalasia: A Long-Term Study Publisher



Tabaeian SP1, 2 ; Anushiravani A3 ; Fazlollahi N3 ; Soleimani HA3 ; Mikaeli J4
Authors
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Authors Affiliations
  1. 1. Department of Internal Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
  2. 2. Colorectal Research Center, Iran University of Medical Sciences, Tehran, Iran
  3. 3. Digestive Diseases Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
  4. 4. Digestive Diseases Research Institute, Tehran University of Medical Sciences, Shariati Hospital, Karegar Shomali Ave, Tehran, Iran

Source: Middle East Journal of Digestive Diseases Published:2021


Abstract

BACKGROUND Three manometric patterns are seen in high-resolution manometry (HRM). Response to treatment has been reported to be different in these subtypes. We aimed to investigate the frequency and response to treatment in subtypes of achalasia. METHODS 306 patients between 15 to 60 years old, naive to treatment with idiopathic achalasia (IA) were evaluated prospectively in a cohort study for 8 years. The patients were treated with pneumatic balloon dilation (PBD), and evaluated before and one month after PBD with Achalasia Symptom Score (ASS) and timed barium esophagogram (TBE) and then every 6 months with ASS. The primary study outcome was defined as a reduction in ASS (equal to or less than 4) and a reduction greater than 80% in the volume of barium in TBE at 1 month after PBD compared with baseline values. RESULTS According to HRM, 57 were classified as type I (18.62%), 223 as type II (72.9%), and 26 as type III (8.5%). The mean lower esophageal sphincter (LES) residual pressures before treatment were 34.05 ± 31.55, 32.99 ± 17.90, and 37.47 ± 14.07 mmHg in types I, II, and III, respectively (p = 0.18). The mean ASS values before treatment were 12.23, 11.50, and 11.50, for types I, II, and III, respectively (p = 0.29). The ASS dropped to 2.50 in type I, 2.40 in type II, and 2.12 in type III at 1 month after treatment (p = 0.83). Eventually, at the end of follow-up, 24 patients with type I (83%), 82 patients with type II (67%), and five patients with type III (83%) showed sustained good responses (p = 0.528). CONCLUSION Manometric subtypes of achalasia did not have an important role in clinical success in the long term. Achalasia has no definite cure, but with current treatment modalities, palliation of symptoms is possible in over 90% of patients. © 2021 The Author(s).
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2. Relationship Between Esophageal Clinical Symptoms and Manometry Findings in Patients With Esophageal Motility Disorders: A Cross-Sectional Study, Medical Journal of the Islamic Republic of Iran (2015)
3. Long-Term Efficacy of Combined Treatment in Patients With Idiopathic Achalasia, Middle East Journal of Digestive Diseases (2021)
4. High-Resolution Esophageal Pressure Topography for Esophageal Motility Disorders, Tehran University Medical Journal (2016)
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