Change in cross-sectional area of esophageal muscle does not correlate with the outcome of achalasia after pneumatic balloon dilatation.
OBJECTIVE
Patients with achalasia have a thicker muscularis propria compared to normal patients. Because pneumatic balloon dilatation (PD) is an effective treatment for achalasia, the changes in the esophageal muscles after PD may predict treatment outcomes, if muscular change is of primary importance. In the present study, we aimed to observe the changes in esophageal muscle thickness following PD and assessed whether symptom relapse can be predicted on the basis of the esophageal muscle cross-sectional area (CSA), as measured by high-frequency intraluminal ultrasound (HFIUS).


METHODS
Fifteen patients treated by PD were studied and followed up for a median of 3.6 years. An HFIUS was done before PD and 6 months after PD. The esophageal muscle CSA measured at the lower esophageal sphincter (LES), and 3 and 6 cm above the LES, was used to see whether any association was present between symptom recurrence and the esophageal muscle CSA.


RESULTS
A single PD resulted in a 2-year remission rate of 66%. A significance variance in change (-65%-248%) was noticed in the muscle CSA after PD. The predilation muscle CSA, post-dilation muscle CSA, and change in the muscle CSA after PD was not associated with symptom recurrence.


CONCLUSIONS
Our findings suggest that measuring the muscle CSA does not help to predict treatment outcome. Muscular changes in achalasia might be just reactive changes.
Sinn
Dong Hyun
DH
Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Choi
Yong Sung
YS
Kim
Jeong Hwan
JH
Kim
Eun Ran
ER
Son
Hee Jung
HJ
Kim
Jae J
JJ
Rhee
Jong Chul
JC
Rhee
Poong-Lyul
PL
D000328:Adult; D002404:Catheterization; D019160:Endosonography; D004931:Esophageal Achalasia / Q000175:diagnosis / Q000628:therapy*; D049630:Esophageal Sphincter, Lower; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000473:pathology / Q000503:physiopathology; D009130:Muscle, Smooth / Q000473:pathology* / Q000503:physiopathology*; D020127:Recovery of Function; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome