title: Multiple good options are available for achalasia management.
abstract: BACKGROUND
  The aim of achalasia management is relieving functional obstruction at the esophagogastric junction. Pneumatic dilation (PD), Heller myotomy (HM), and Botox (BT) are available for this purpose. Many studies have compared efficacy of one treatment regimen to another however, many patients with achalasia undergo combinations of different procedures.
  
  
  OBJECTIVE
  : The aim of this study was to follow-up achalasia patients treated at a tertiary referral center over a 10-year period and to compare patient satisfaction and symptoms in patients who were treated with either a single treatment (ST) versus multiple treatments (MT).
  
  
  METHODS
  A cohort of achalasia patients treated at the Medical University of South Carolina between 2002 and 2012 were identified, contacted by telephone, and completed a questionnaire about their treatments and symptoms. Symptomatic response was classified using the Eckardt score, and overall patient satisfaction was determined on a scale from 1 to 10. Data were analyzed using a paired Student t test.
  
  
  RESULTS
  Data were collected from 57 patients and 3 patients were excluded from the study because they had no prior interventions for achalasia. Demographic analysis of the patients revealed a mean age of 62.7 years (range, 24 to 89 y) with 45% males and 55% females. The average elapsed time since the last definitive treatment was 2.82 years. Twenty-eight patients had an ST performed and 26 patients underwent MT. The average number of different interventions in the MT group was 3 procedures/patient. There were no significant differences in overall patient satisfaction (ST, 7.5 vs. MT, 8; P=0.66) and the Eckardt scores between the 2 groups (ST, 3.39 vs. MT, 3.3; P=0.77).
  
  
  CONCLUSIONS
  MT options are available for management of achalasia. Improvement of clinical symptoms and overall patient satisfaction does not differ if the patient underwent an ST modality or a combination of different treatments.
authors.affiliation: *Division of Digestive Diseases and Nutrition, University of South Florida College of Medicine, Tampa, FL †Digestive Disease Center Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, SC.
authors.forename: Steven B
authors.initials: SB
authors.lastname: Clayton
authors.forename: Donald O
authors.initials: DO
authors.lastname: Castell
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001905:Botulinum Toxins / Q000009:adverse effects / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D013505:Digestive System Surgical Procedures / Q000009:adverse effects; D004106:Dilatation; D004931:Esophageal Achalasia / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D049630:Esophageal Sphincter, Lower / Q000187:drug effects* / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000009:adverse effects / Q000627:therapeutic use*; D017060:Patient Satisfaction; D020127:Recovery of Function; D012189:Retrospective Studies; D013022:South Carolina; D011795:Surveys and Questionnaires; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D009465:Neuromuscular Agents; D001905:Botulinum Toxins