title: Residual lower esophageal sphincter pressure as a prognostic factor in the pneumatic balloon treatment of achalasia.
abstract: OBJECTIVE
  Pneumatic balloon dilatation (PD) is a mainstay in achalasia treatment. The aim of this study was to identify predictive factors for successful treatment.
  
  
  METHODS
  We retrospectively reviewed 76 patients with a diagnosis of achalasia who underwent PD from June 2010 to May 2013. Clinical symptoms were assessed using Eckardt score and manometry data were analyzed using resting and relaxation pressure (4sIRP) of lower esophageal sphincter (LES) and the distal contractile integral (DCI), which was calculated for 10 s from the start of deglutition between the upper margin of the LES and lower margin of upper esophageal contraction. Patients with achalasia were classified into three groups based on the Chicago classification.
  
  
  RESULTS
  Among 76 patients, 52 patients received PD, and the treatment was unsuccessful in 9 patients (6 in class I and 3 in class III). When comparing prognostic factors between successful and unsuccessful treatment groups, the mean value for 4sIRP in the unsuccessful treatment group was significantly lower than that in the successful treatment group (P < 0.05). However, no difference was noticed in resting LES pressure, DCI, age, and sex. Furthermore, a lower mean value of 4sIRP was significantly related to unsuccessful treatment of achalasia (odds ratio, 1.092; 95% confidence interval, 1.001-1.191) even after adjustment for a series of confounding factors.
  
  
  CONCLUSIONS
  Lower 4sIRP may be a prognostic indicator for poor treatment outcome after PD.
authors.affiliation: Department of Internal Medicine, Sungkyunkwan University College of Medicine, Seoul, Korea.
authors.forename: Jung Ho
authors.initials: JH
authors.lastname: Park
authors.forename: Yong Chan
authors.initials: YC
authors.lastname: Lee
authors.forename: Hyuk
authors.initials: H
authors.lastname: Lee
authors.forename: Hyojin
authors.initials: H
authors.lastname: Park
authors.forename: Young Hoon
authors.initials: YH
authors.lastname: Youn
authors.forename: Hyung Seok
authors.initials: HS
authors.lastname: Park
authors.forename: Tae Hee
authors.initials: TH
authors.lastname: Lee
authors.forename: Kyoung Sup
authors.initials: KS
authors.lastname: Hong
mesh_terms: D000328:Adult; D000368:Aged; D004106:Dilatation / Q000379:methods*; D004931:Esophageal Achalasia / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D049630:Esophageal Sphincter, Lower / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: Chicago classification; Heller myotomy; achalasia; pneumatic balloon dilatation