title: Long-term outcome following pneumatic dilatation as initial therapy for idiopathic achalasia: an 18-year single-centre experience.
abstract: BACKGROUND
  Relapse after treatment for idiopathic achalasia is common and long-term outcome data are limited.
  
  
  OBJECTIVE
  To determine the cumulative relapse rate and long-term outcome after pneumatic dilatation (PD) for achalasia in a tertiary referral centre.
  
  
  METHODS
  A retrospective study of 301 patients with achalasia treated with PD as first-line therapy. Short-term outcome was measured at 12 months. Long-term outcome was assessed in those who were in remission at 12 months by cumulative relapse rate and cross-sectional analysis of long-term remission rate regardless of any interval therapy, using a validated achalasia-specific questionnaire.
  
  
  RESULTS
  Eighty-two percent of patients were in remission 12 months following initial PD. Relapse rates thereafter were 18% by 2 years; 41% by 5 years and 60% by 10 years. Whilst 43% patients underwent additional treatments [PD (29%), myotomy (11%) or botulinum toxin (3%)] beyond 12 months, 32% of those who had not received interval therapy had relapsed at cross-sectional analysis. After a mean follow-up of 9.3 years, regardless of nature, timing or frequency of any interval therapy, 71% (79/111) patients were in remission. The perforation rate from PD was 2%. Chest pain had a poor predictive value (24%) for perforation.
  
  
  CONCLUSIONS
  Long-term relapse is common following pneumatic dilatation. While on-demand pneumatic dilatation for relapse yields a good response, one-third of relapsers neither seek medical attention nor receive interval therapy. Close follow-up with timely repeat dilatation is necessary for a good long-term outcome. Given the poor predictive value of chest pain for perforation, routine gastrografin swallow is recommended postdilatation.
authors: Department of Gastroenterology and Hepatology, St George Hospital, University of New South Wales, Sydney, NSW, Australia.
authors: T R
authors: TR
authors: Elliott
authors: P I
authors: PI
authors: Wu
authors: S
authors: S
authors: Fuentealba
authors: M
authors: M
authors: Szczesniak
authors: D J
authors: DJ
authors: de Carle
authors: I J
authors: IJ
authors: Cook
mesh_terms: D003430:Cross-Sectional Studies; D004106:Dilatation / Q000379:methods*; D004931:Esophageal Achalasia / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome