title: The Impact of Heller Myotomy on Integrated Relaxation Pressure in Esophageal Achalasia.
abstract: BACKGROUND
  A new high-resolution manometry (HRM) parameter, the integrated relaxation pressure (IRP), has been proposed for the assessment of esophageal-gastric junction (EGJ) relaxation. Our aim was to assess the effect of Heller myotomy on IRP in achalasia patients.
  
  
  METHODS
  We prospectively collected data on achalasia patients who underwent HRM between 2009-2014. Barium swallow was used to assess esophageal diameter and shape. Manometric diagnoses were performed by using the Chicago Classification v3. All patients with a confirmed diagnosis of achalasia were treated surgically with Heller Myotomy
  
  
  RESULTS
  One hundred thirty-nine consecutive achalasia patients (M:F = 72:67) represented the study population. All the patients had 100% simultaneous waves but 11 had an IRP < 15 mmHg. At median follow-up of 28 months, the median of IRP was significantly lower after surgery (27.4 [IQR 20.4-35] vs 7.1 [IQR 4.4-9.8]; p < 0.001), and so were the lower esophageal sphincter (LES) resting pressure (27 [IQR 18-33] vs 6 [IQR 3-11]; p < 0.001). At univariate analysis, IRP correlated with the gender, LES resting residual pressure, and dysphagia score.
  
  
  CONCLUSIONS
  This is the first study to have examined the role of IRP in achalasia, and how it changes after surgical treatment. An increased preoperative IRP correlated directly with a more severe dysphagia. The IRP was restored to normal by Heller myotomy.
authors.affiliation: Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, School of Medicine, Padova, Italy. renato.salvador@libero.it.
authors.forename: Renato
authors.initials: R
authors.lastname: Salvador
authors.affiliation: Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, School of Medicine, Padova, Italy.
authors.forename: Edoardo
authors.initials: E
authors.lastname: Savarino
authors.affiliation: Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, School of Medicine, Padova, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Pesenti
authors.affiliation: Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, School of Medicine, Padova, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Spadotto
authors.affiliation: Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, School of Medicine, Padova, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Capovilla
authors.affiliation: Surgical Oncology Unit, Veneto Institute of Oncology (IOV-IRCCS), Padua, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Cavallin
authors.affiliation: Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, School of Medicine, Padova, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Galeazzi
authors.affiliation: Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, School of Medicine, Padova, Italy.
authors.forename: Loredana
authors.initials: L
authors.lastname: Nicoletti
authors.affiliation: Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, School of Medicine, Padova, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Merigliano
authors.affiliation: Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, School of Medicine, Padova, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Costantini
mesh_terms: D003680:Deglutition Disorders / Q000209:etiology / Q000601:surgery; D004931:Esophageal Achalasia / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery*; D004943:Esophagogastric Junction / Q000503:physiopathology*; D004947:Esophagus / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011312:Pressure
keywords: Achalasia; Heller myotomy; High-resolution manometry; Integrated relaxation pressure