title: Clinical, radiological and functional assessment of pulmonary status in patients with achalasia cardia before and after treatment.
abstract: OBJECTIVE
  Patients with achalasia have respiratory symptoms due to chronic microaspiration. Achalasia can lead to radiological and functional changes in the lung. We studied the effect of either balloon dilatation or laparoscopic Heller's cardiomyotomy on the reversal of these changes in the lung.
  
  
  METHODS
  Thirty patients with achalasia were included in this study. Oesophageal symptoms and pulmonary symptoms were recorded. Pulmonary function tests (PFTs) were done at baseline and at the end of 6 months. High-resolution computed tomography of the chest was performed prior to treatment and repeated 6 months after treatment if found abnormal at the initial evaluation.
  
  
  RESULTS
  The mean age of the patients was 30.97 years and mean duration of symptoms was 22.5 months. Fifteen patients (50%) had respiratory symptoms, nocturnal cough being the commonest symptom in 13 (43.3%). Thirteen patients (43.3%) had parenchymal lung changes on high-resolution computed tomography (HRCT). Eight patients (28.5%) had functional abnormalities in the lungs in the form of restrictive airway disease. Nineteen patients opted for Laparoscopic Heller's cardiomyotomy, while 11 patients underwent pneumatic dilatation. Six months after treatment, the respiratory symptoms resolved in all except two patients (13.3%). Four patients (66.6%) with active lung changes at HRCT showed resolution at 6 months. There was improvement in functional parameters on PFT evaluation with normalization of PFT in one patient.
  
  
  CONCLUSIONS
  Pulmonary symptoms as well as radiological and functional abnormalities are common in patients with achalasia. Treatment in the form of pneumatic dilatation or Lap cardiomyotomy improves pulmonary symptoms.
authors: Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India. drrajinderparshad@aiims.ac.in
authors: Rajinder
authors: R
authors: Parshad
authors: Sudheer Kumar
authors: SK
authors: Devana
authors: Karthik
authors: K
authors: Panchanatheeswaran
authors: Anoop
authors: A
authors: Saraya
authors: Govind K
authors: GK
authors: Makharia
authors: Surendra Kumar
authors: SK
authors: Sharma
authors: Ashu Seith
authors: AS
authors: Bhalla
mesh_terms: D000293:Adolescent; D000328:Adult; D002299:Cardia / Q000601:surgery*; D004106:Dilatation; D004931:Esophageal Achalasia / Q000150:complications / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume; D018662:Fundoplication; D006801:Humans; D010535:Laparoscopy; D008171:Lung Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014797:Vital Capacity; D055815:Young Adult