title: Heller's myotomy and pneumatic dilatation in the treatment of achalasia: a population-based case-control study assessing long-term quality of life.
abstract: Long-term health-related quality-of-life (HRQL) outcomes have not been widely reported in the treatment of achalasia. The aims of this study were to examine long-term disease-specific and general HRQL in achalasia patients using a population-based case-control method, and to assess HRQL between treatment interventions. Manometrically diagnosed achalasia cases (n = 120) were identified and matched with controls (n = 115) using a population-based approach. Participants completed general (SF-12) and disease-specific (Achalasia Severity Questionnaire [ASQ]) HRQL questionnaires, as appropriate, in a structured interview. Mean composite scores for SF-12 (Mental Component Summary score [MCS-12] and Physical Component Summary score [PCS-12]) and ASQ were compared between cases and controls, or between intervention groups, using an independent t-test. Adjusted mean differences in HRQL scores were evaluated using a linear regression model. Achalasia cases were treated with a Heller's myotomy (n = 43), pneumatic dilatation (n = 44), or both modalities (n = 33). The median time from last treatment to HRQL assessment was 5.7 years (interquartile range 2.4-11.5). Comparing achalasia patients with controls, PCS-12 was significantly worse (40.9 vs. 44.2, P = 0.01), but MCS-12 was similar. However, both PCS-12 (39.9 vs. 44.2, P = 0.03) and MCS-12 (46.7 vs. 53.5, P = 0.004) were significantly impaired in those requiring dual treatment compared with controls. Overall however, there was no difference in adjusted HRQL between patients treated with Heller's myotomy, pneumatic dilatation or both treatment modalities. In summary, despite treatment achalasia patients have significantly worse long-term physical HRQL compared with population controls. No HRQL differences were observed between the treatment modalities to suggest a benefit of one treatment over another.
authors.affiliation: Cancer Epidemiology and Health Services Research Group, Centre for Public Health, Queen's University Belfast,  Northern Ireland, UK.
authors.forename: R T
authors.initials: RT
authors.lastname: Gray
authors.affiliation: Cancer Epidemiology and Health Services Research Group, Centre for Public Health, Queen's University Belfast,  Northern Ireland, UK.
authors.forename: H G
authors.initials: HG
authors.lastname: Coleman
authors.affiliation: Cancer Epidemiology and Health Services Research Group, Centre for Public Health, Queen's University Belfast,  Northern Ireland, UK.
authors.forename: K W
authors.initials: KW
authors.lastname: Lau
authors.affiliation: Regional Virus Laboratory, Kelvin Building, Belfast Health and Social Care Trust, Royal Victoria Hospital, Belfast, Northern Ireland, UK.
authors.forename: C
authors.initials: C
authors.lastname: McCaughey
authors.affiliation: Regional Virus Laboratory, Kelvin Building, Belfast Health and Social Care Trust, Royal Victoria Hospital, Belfast, Northern Ireland, UK.
authors.forename: P V
authors.initials: PV
authors.lastname: Coyle
authors.affiliation: Cancer Epidemiology and Health Services Research Group, Centre for Public Health, Queen's University Belfast,  Northern Ireland, UK.
authors.forename: L J
authors.initials: LJ
authors.lastname: Murray
authors.affiliation: Department of Gastroenterology, Belfast Health and Social Care Trust, Belfast, Northern Ireland, UK.
authors.forename: B T
authors.initials: BT
authors.lastname: Johnston
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D004106:Dilatation / Q000379:methods* / Q000523:psychology; D004931:Esophageal Achalasia / Q000523:psychology / Q000601:surgery*; D004945:Esophagoscopy / Q000379:methods* / Q000523:psychology; D005260:Female; D006801:Humans; D007494:Ireland; D010535:Laparoscopy / Q000379:methods* / Q000523:psychology; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011788:Quality of Life; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013995:Time; D016896:Treatment Outcome
keywords: achalasia; quality of life