Respiratory Dysfunction Is Common in Patients with Achalasia and Improves After Pneumatic Dilation

Background Dysphagia, regurgitation, and chest pain are common achalasia, with a variable report of pulmonary symptoms possibly due to micro-aspiration. Pneumatic dilation (PD) may improve pulmonary function. Data on pulmonary dysfunction among achalasia patients are scanty, and the effect of PD is...

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Published in:Digestive diseases and sciences 2014-04, Vol.59 (4), p.744-752
Main Authors: Gupta, Mahesh, Ghoshal, Uday C., Jindal, Shikha, Misra, Asha, Nath, Alok, Saraswat, Vivek A.
Format: Article
Language:English
Subjects:
Achalasia
Adolescent
Adult
Algorithms
Biochemistry
Care and treatment
CT imaging
Diagnosis
Dilatation - methods
Esophageal Achalasia - complications
Esophageal Achalasia - therapy
Female
Gastroenterology
Hepatology
Humans
Lung Diseases - etiology
Lung Diseases - physiopathology
Lung Diseases - therapy
Male
Manometry
Medicine
Medicine & Public Health
Middle Aged
Oncology
Original Article
Pneumoviridae
Respiratory Function Tests
Transplant Surgery
Young Adult
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Summary:Background Dysphagia, regurgitation, and chest pain are common achalasia, with a variable report of pulmonary symptoms possibly due to micro-aspiration. Pneumatic dilation (PD) may improve pulmonary function. Data on pulmonary dysfunction among achalasia patients are scanty, and the effect of PD is unknown. Aim To evaluate pulmonary dysfunction in patients with achalasia based on clinical and radiologic evaluation and spirometry and to study the effect of PD at 1-month follow-up. Methods Patients with achalasia (diagnosed using high-resolution manometry and the Chicago classification) were evaluated prospectively by spirometry before ( n  = 38) and 1 month after PD ( n  = 31). All patients received a chest X-ray, and patients with respiratory abnormality before PD received high-resolution computed tomography of the thorax. Results Of the 38 patients, 17 and 21 had type I and II achalasia, respectively. The respiratory symptoms, such as pharyngeal symptoms [27/38 (71 %) vs. 8/31 (26 %); P  = 0.0001], cough [23/38 (60.5 %) vs. 5/31 (16 %), P  = 0.0001], and dyspnea [8/38 (21 %) vs. 0/31 (0 %), P  = 0.006], improved after treatment with PD. Spirometry showed abnormalities in 17/38 (45 %) patients before and in 8/15 (53 %) after PD. Median FEV 1 , FVC, PEFR, and percentage of predicted MEF 25–75 , improved from 78 % (36–85), 74 % (48–100), 62 % (18–72), and 48 % (15–66) before to 83 % (58–94), 86 % (55–99), 69 % (38–81), and 59 % (33–78) after PD, respectively ( P  
ISSN:0163-2116
1573-2568
DOI:10.1007/s10620-013-2971-8