title: Respiratory dysfunction is common in patients with achalasia and improves after pneumatic dilation.
abstract: BACKGROUND
  Dysphagia, regurgitation, and chest pain are common achalasia, with a variable report of pulmonary symptoms possibly due to micro-aspiration. Pneumatic dilation (PD) may improve pulmonary function. Data on pulmonary dysfunction among achalasia patients are scanty, and the effect of PD is unknown.
  
  
  OBJECTIVE
  To evaluate pulmonary dysfunction in patients with achalasia based on clinical and radiologic evaluation and spirometry and to study the effect of PD at 1-month follow-up.
  
  
  METHODS
  Patients with achalasia (diagnosed using high-resolution manometry and the Chicago classification) were evaluated prospectively by spirometry before (n = 38) and 1 month after PD (n = 31). All patients received a chest X-ray, and patients with respiratory abnormality before PD received high-resolution computed tomography of the thorax.
  
  
  RESULTS
  Of the 38 patients, 17 and 21 had type I and II achalasia, respectively. The respiratory symptoms, such as pharyngeal symptoms [27/38 (71 %) vs. 8/31 (26 %); P = 0.0001], cough [23/38 (60.5 %) vs. 5/31 (16 %), P = 0.0001], and dyspnea [8/38 (21 %) vs. 0/31 (0 %), P = 0.006], improved after treatment with PD. Spirometry showed abnormalities in 17/38 (45 %) patients before and in 8/15 (53 %) after PD. Median FEV(1), FVC, PEFR, and percentage of predicted MEF(25-75), improved from 78 % (36-85), 74 % (48-100), 62 % (18-72), and 48 % (15-66) before to 83 % (58-94), 86 % (55-99), 69 % (38-81), and 59 % (33-78) after PD, respectively (P < 0.05 for all).
  
  
  CONCLUSIONS
  Respiratory symptoms and spirometry abnormalities are common in patients with achalasia and improved after successful PD.
authors.affiliation: Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India.
authors.forename: Mahesh
authors.initials: M
authors.lastname: Gupta
authors.forename: Uday C
authors.initials: UC
authors.lastname: Ghoshal
authors.forename: Shikha
authors.initials: S
authors.lastname: Jindal
authors.forename: Asha
authors.initials: A
authors.lastname: Misra
authors.forename: Alok
authors.initials: A
authors.lastname: Nath
authors.forename: Vivek A
authors.initials: VA
authors.lastname: Saraswat
mesh_terms: D000293:Adolescent; D000328:Adult; D000465:Algorithms; D004106:Dilatation / Q000379:methods; D004931:Esophageal Achalasia / Q000150:complications / Q000628:therapy*; D005260:Female; D006801:Humans; D008171:Lung Diseases / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008365:Manometry; D008875:Middle Aged; D012129:Respiratory Function Tests; D055815:Young Adult