Timed barium oesophagram: better predictor of long term success after pneumatic dilation in achalasia than symptom assessment

Background: Symptom relief post pneumatic dilation is traditionally used to assess treatment success in achalasia patients. Recently, we showed that symptom relief and objective oesophageal emptying are concordant in about 70% of patients, while up to 30% of achalasia patients report near complete s...

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Bibliographic Details
Published in:Gut 2002-06, Vol.50 (6), p.765-770
Main Authors: Vaezi, M F, Baker, M E, Achkar, E, Richter, J E
Format: Article
Language:English
Subjects:
Achalasia
Adult
Aged
Barium
Barium Sulfate
Biological and medical sciences
Care and treatment
Catheterization - methods
Catheters
Contrast Media
Digestive system
Esophageal Achalasia - diagnostic imaging
Esophageal Achalasia - therapy
Esophagogastric junction
Esophagus
Female
Humans
Investigative techniques, diagnostic techniques (general aspects)
Long term
LOS
lower oesophageal sphincter
Male
Medical examination
Medical sciences
Middle Aged
Motility
Oesophagus
Patients
pneumatic dilation
Radiodiagnosis. Nmr imagery. Nmr spectrometry
Radiography
Success
Time Factors
timed barium oesophagram
Treatment Outcome
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Summary:Background: Symptom relief post pneumatic dilation is traditionally used to assess treatment success in achalasia patients. Recently, we showed that symptom relief and objective oesophageal emptying are concordant in about 70% of patients, while up to 30% of achalasia patients report near complete symptom relief despite poor oesophageal emptying of barium. Aims: We now report the results of long term clinical follow up in these two groups of achalasia patients, assessing differences in symptomatic remission rates. Methods: Achalasia patients undergoing pneumatic dilation since 1995 were evaluated both symptomatically and objectively at regular intervals. Pre and post dilation symptoms were recorded. Barium column height was measured five minutes after ingesting a fixed volume of barium per patient to assess oesophageal emptying. Patients who initially reported near complete symptom relief were divided into two groups based on objective findings on barium study: (1) complete oesophageal emptying (concordant group), and (2) poor oesophageal emptying (discordant group). Patients were followed prospectively for symptom recurrence. Results: Thirty four patients with complete symptom relief post pneumatic dilation were identified. In 22/34 (65%) patients, the degree of symptom and barium height improvements was similar (concordant group). In 10/34 (30%) patients, there was < 50% improvement in barium height (discordant group). Significantly (p
ISSN:0017-5749
1468-3288
1458-3288
DOI:10.1136/gut.50.6.765