title: Predictors of short term treatment outcome in patients with achalasia following endoscopic or surgical therapy.
abstract: OBJECTIVE
  Pneumatic balloon dilation and surgical myotomy are the most effective treatments for achalasia. While there is controversy which method is best, the aim of the current study was to identify predictors of symptom recurrence after endoscopic or surgical therapy.
  
  
  METHODS
  Patients undergoing pneumatic balloon dilatation (30mm) or laparoscopic Heller myotomy with Dor fundoplication were included in the study. Analyzed parameters include total symptom score (sum of 0-5 point intensity for dysphagia, regurgitation and chest pain), width and height of esophageal column at 2 and 5 minutes after oral barium ingestion, lower esophageal sphincter (LES) length, resting (LESP) and residual pressure (LESRP) before and 3 months after intervention. Patients with symptoms score <3 at the 3-month follow-up visit were considered asymptomatic.
  
  
  RESULTS
  Twenty-one patients underwent pneumatic dilation (14) or laparoscopic myotomy (7). Total symptom score improved (p<0.01) from pre- (7.2±2.7) to post-intervention (1.7±2.6). Eleven (85.8%) patients in the endoscopic group vs. 7 (100%) patients in the surgical group were symptom-free 3 months after intervention. Therapies improved LESP (24.4±8.2mmHg pre- vs. 15.4±10.3mmHg post-therapy; p=0.003) and mean LESRP (7.9±4.3mmHg pre- vs. 5.3±6.7mmHg post-therapy; p=0.03). Univariate linear regression analysis identified barium contrast column width >5cm at 2 minutes (p=0.04), LES length <2cm (p=0.003) and LESRP >10mmHg (p=0.02) as predictors for persistent symptoms.
  
  
  CONCLUSIONS
  While >85% of achalasia patients responded well to 30mm pneumatic balloon dilation, patients with elevated LES pressure, short LES and wide esophagus should be considered as primary surgical candidates.
authors.affiliation: Fundeni Clinical Institute, Bucharest, Romania.
authors.forename: Cristian
authors.initials: C
authors.lastname: Gheorghe
authors.forename: Ion
authors.initials: I
authors.lastname: Bancila
authors.forename: Radu
authors.initials: R
authors.lastname: Tutuian
authors.forename: Razvan
authors.initials: R
authors.lastname: Iacob
authors.forename: Victor
authors.initials: V
authors.lastname: Tomulescu
mesh_terms: D000328:Adult; D000368:Aged; D001466:Barium Sulfate; D002637:Chest Pain / Q000209:etiology / Q000601:surgery; D016009:Chi-Square Distribution; D003287:Contrast Media; D003680:Deglutition Disorders / Q000209:etiology / Q000601:surgery; D004106:Dilatation; D004931:Esophageal Achalasia / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D016629:Esophagectomy / Q000009:adverse effects; D004945:Esophagoscopy / Q000009:adverse effects; D004947:Esophagus / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D018662:Fundoplication / Q000009:adverse effects; D005764:Gastroesophageal Reflux / Q000209:etiology / Q000601:surgery; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D016014:Linear Models; D008297:Male; D008365:Manometry; D008875:Middle Aged; D018579:Patient Selection; D011237:Predictive Value of Tests; D011312:Pressure; D011446:Prospective Studies; D011859:Radiography; D012008:Recurrence; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D003287:Contrast Media; D001466:Barium Sulfate