title: Changes in pressure waves after endoscopic intervention in patients with achalasia: A focus on peristaltic recovery of the esophageal body.
abstract: OBJECTIVE
  We conducted the present study to investigate the recovery of peristalsis of the esophageal body and evaluate the pressure changes observed on manometry before and after endoscopic intervention.
  
  
  METHODS
  Forty-five patients were diagnosed with achalasia, and 36 received endoscopic or surgical treatment. We collected the data of 24 patients who underwent manometry before and after treatment (pneumatic balloon dilatation, n=7; botulinum toxin injection, n=10; peroral endoscopic myotomy, n=7).
  
  
  RESULTS
  The lower esophageal sphincter (LES) resting pressure and nadir LES relaxation pressure decreased regardless of the achalasia subtype or type of endoscopic intervention following treatment (p<0.05). Among patients with a nadir LES relaxation pressure of <4 mmHg, 42.9% (6/14) exhibited partial esophageal peristaltic wave recovery. However, no patients with a nadir LES relaxation pressure of >4 mmHg exhibited peristaltic wave recovery (p=0.024). Of the six patients with peristaltic wave recovery, two had type I achalasia (15.4%), three had type II (33.3%), and one had type III (100.0%). The Eckardt score, symptom duration, and type of intervention were not associated with the recovery of peristaltic waves.
  
  
  CONCLUSIONS
  Our results suggest that normalization of the nadir LES relaxation pressure can be a predictive factor for the recovery of esophageal peristalsis.
authors.affiliation: Department of Internal Medicine, Digestive Disease Center and Research Institute, Soonchunhyang University College of Medicine, Bucheon, Korea. sjhong@schmc.ac.kr.
authors.forename: Se Kyung
authors.initials: SK
authors.lastname: Park
authors.forename: Su Jin
authors.initials: SJ
authors.lastname: Hong
authors.forename: Jae Pil
authors.initials: JP
authors.lastname: Han
authors.forename: Hyeon Jeong
authors.initials: HJ
authors.lastname: Goong
authors.forename: Hyun Soo
authors.initials: HS
authors.lastname: Kim
authors.forename: Yu Sik
authors.initials: YS
authors.lastname: Myung
authors.forename: Shin Hee
authors.initials: SH
authors.lastname: Kim
authors.forename: Hee Jae
authors.initials: HJ
authors.lastname: Jung
authors.forename: Tae Hee
authors.initials: TH
authors.lastname: Lee
authors.forename: Joon Seong
authors.initials: JS
authors.lastname: Lee
authors.forename: Moon Sung
authors.initials: MS
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004931:Esophageal Achalasia / Q000503:physiopathology* / Q000601:surgery; D004945:Esophagoscopy / Q000379:methods / Q000534:rehabilitation*; D004947:Esophagus / Q000503:physiopathology / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D010528:Peristalsis / Q000502:physiology*; D011312:Pressure; D020127:Recovery of Function / Q000502:physiology*; D016896:Treatment Outcome; D055815:Young Adult