High-resolution manometry is comparable to timed barium esophagogram for assessing response to pneumatic dilation in patients with achalasia.
BACKGROUND
Reduction in height of barium column in timed barium esophagogram (TBE) and lower esophageal sphincter (LES) pressure on manometry has been used to assess efficacy of pneumatic dilation (PD) in patients with achalasia; data comparing these two methods to assess efficacy of PD are scanty.


METHODS
Sixty-two patients with achalasia undergoing PD were evaluated clinically (Eckardt's score), high-resolution manometry (HRM), and TBE (films at 1 and 5 min) before and 4 weeks after PD using 30 and 35 mm Rigiflex balloon (Microvasive, Milliford, MA, USA) in female and male patients, respectively. Response was defined clinically as Eckardt's score <3, by manometry as LES pressure <22.5 mmHg, and by TBE as adequate esophageal emptying (reduction in height of barium column by more than 50 % of pretreatment value in 5-min radiograph).


RESULTS
Forty-three out of sixty-two (69 %) patients [age 34 ± 12 years, 36 (58 %) male] responded, and 19 (31 %) did not respond to the first session of PD as assessed by post-PD Eckardt's score. Thirty-eight out of 43 (88 %) responders had adequate esophageal emptying of barium in TBE, while 31/43 (72 %) had LES pressure below 22.5 mmHg on HRM (p = ns). Eight out of 19 (42 %) nonresponders showed failure in esophageal emptying (defined by lack of reduction in height of barium column by 50 %) in TBE, and 11/19 (58 %) had LES pressure >22.5 mmHg (p = ns). Kaplan-Meier analysis showed that response on TBE and HRM at 1 month predicted clinical response well during 6 months follow up.


CONCLUSIONS
TBE and esophageal HRM were comparable in assessing efficacy of PD in treatment of achalasia.
Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Rae Bareli Road, Lucknow, 226 014, India, udayghoshal@yahoo.co.in.
Uday C
UC
Ghoshal
Mahesh
M
Gupta
Abhai
A
Verma
Zafar
Z
Neyaz
Samir
S
Mohindra
Asha
A
Misra
Vivek A
VA
Saraswat
D000328:Adult; D017609:Barium Compounds; D003287:Contrast Media; D004106:Dilatation / Q000379:methods*; D004931:Esophageal Achalasia / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D049630:Esophageal Sphincter, Lower / Q000503:physiopathology*; D004947:Esophagus / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011859:Radiography; D016896:Treatment Outcome; D055815:Young Adult
D017609:Barium Compounds; D003287:Contrast Media