title: Upper esophageal sphincter abnormalities are strongly predictive of treatment response in patients with achalasia.
abstract: OBJECTIVE
  To investigate the relationship between upper esophageal sphincter abnormalities achalasia treatment
  
  
  METHODS
  We performed a retrospective study of 41 consecutive patients referred for high resolution esophageal manometry with a final manometric diagnosis of achalasia. Patients were sub-divided by presence or absence of Upper esophageal sphincter (UES) abnormality, and clinical and manometric profiles were compared. Correlation between UES abnormality and sub-type (i.e., hypertensive, hypotensive or impaired relaxation) and a number of variables, including qualitative treatment response, achalasia sub-type, co-morbid medical illness, psychiatric illness, surgical history, dominant presenting symptom, treatment type, age and gender were also evaluated.
  
  
  RESULTS
  Among all 41 patients, 24 (58.54%) had a UES abnormality present. There were no significant differences between the groups in terms of age, gender or any other clinical or demographic profiles. Among those with UES abnormalities, the majority were either hypertensive (41.67%) or had impaired relaxation (37.5%) as compared to hypotensive (20.83%), although this did not reach statistical significance (P = 0.42). There was no specific association between treatment response and treatment type received; however, there was a significant association between UES abnormalities and treatment response. In patients with achalasia and concomitant UES abnormalities, 87.5% had poor treatment response, while only 12.5% had favorable response. In contrast, in patients with achalasia and no UES abnormalities, the majority (78.57%) had good treatment response, as compared to 21.43% with poor treatment response (P = 0.0001). After controlling for achalasia sub-type, those with UES abnormality had 26 times greater odds of poor treatment response than those with no UES abnormality (P = 0.009). Similarly, after controlling for treatment type, those with UES abnormality had 13.9 times greater odds of poor treatment response compared to those with no UES abnormality (P = 0.017).
  
  
  CONCLUSIONS
  The presence of UES abnormalities in patients with achalasia significantly predicted poorer treatment response as compared to those with normal UES function.
authors.affiliation: Simon C Mathews, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21224, United States.
authors.forename: Simon C
authors.initials: SC
authors.lastname: Mathews
authors.affiliation: Simon C Mathews, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21224, United States.
authors.forename: Maria
authors.initials: M
authors.lastname: Ciarleglio
authors.affiliation: Simon C Mathews, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21224, United States.
authors.forename: Yamile Haito
authors.initials: YH
authors.lastname: Chavez
authors.affiliation: Simon C Mathews, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21224, United States.
authors.forename: John O
authors.initials: JO
authors.lastname: Clarke
authors.affiliation: Simon C Mathews, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21224, United States.
authors.forename: Ellen
authors.initials: E
authors.lastname: Stein
authors.affiliation: Simon C Mathews, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21224, United States.
authors.forename: Bani
authors.initials: B
authors.lastname: Chander Roland
keywords: Achalasia; Dysphagia; Esophageal disorders; Motility; Upper esophageal sphincter