Background/Aims: A new classification of achalasia using high-resolution manometry (HRM) has recently been suggested. Pneumatic dilatation (PD) is a common treatment for primary achalasia. The usefulness of the new classification and HRM for the treatment and follow-up of patients after PD is unknown. The aim of this study was to evaluate the PD effectiveness and the predictive factors of success in Japanese patients with achalasia using HRM and the new classification of achalasia. Methods: Twenty-five patients were diagnosed with primary achalasia using HRM and treated by PD in our hospital. We evaluated symptom scores and esophageal manometry 6 and 12 months after the first PD. Results: After the first PD treatment, remission occurred in 24 out of 25 (96.0%) patients at 6 months and in 19 out of 25 (76.0%) patients at 12 months. With the new classification of achalasia, the success rates were 83.3, 80.0 and 50% for types I, II and III, respectively, 12 months after PD. The median age of the successful group was significantly greater than that of the failure group (47.1 vs. 37.0 years, p <0.05). The median residual lower esophageal sphincter (LES) pressure 6 months after PD in the successful group was significantly lower than that of the failure group (9.0 vs. 15.5 mm Hg, p <0.05). Conclusion: Good predictors of PD success were old age (>40 years) and residual LES pressures less than 15 mm Hg 6 months after PD.

Journal Section:
Original Paper
Keywords:
Primary achalasia, Pneumatic dilatation, High-resolution manometry, New classification of achalasia
1.
Cohen S, Fisher R, Tuch A, et al: The site of denervation in achalasia. Gut 1972;13:556–558.
[PubMed]
https://doi.org/10.1136%2Fgut.13.7.556
2.
Mayberry JF: Epidemiology and demographics of achalasia. Gastrointest Endosc Clini N Am 2001;11:235–248.
[PubMed]
3.
Vaezi MF, Richter JE: Current therapies for achalasia. J Clin Gastroenterol 1998;27:21–35.
[PubMed]
https://doi.org/10.1097%2F00004836-199807000-00006
4.
Tanaka Y, Iwakiri K, Kawami N, Sano Hiroshi, Umezawa M, Kotoyori M, Hoshihara Y, Nomura T, Miyashita M, Sakamoto C: Predictor of a better outcome of pneumatic dilatation in patients with primary achalasia. J Gastroenterol 2010;45:153–158.
[PubMed]
https://doi.org/10.1007%2Fs00535-009-0145-4
5.
Eckardt VF, Aignhrr C, Bernhard G: Predictors of outcome in patients with achalasia treated by pneumatic dilation. Gastroenterology 1992;103:1732–1738.
[PubMed]
6.
West RL, Hirsch DP, Bartelsman JFWM, Borst J, Ferwerda G, Tytgat GNJ, Boeckxstaens GE: Long term results of pneumatic dilatation in achalasia followed for more than 5 years. Am J Gastroenterol 2002;97:1346–1351.
[PubMed]
https://doi.org/10.1016%2FS0002-9270%2802%2904127-8
7.
Torbey CF, Achkar E, Rice TW, Baker M, Rchter JE: Long-term outcome of achalasia treatment: the need for closer follow up. J Clin Gastroenterol 1999;28:125–130.
[PubMed]
https://doi.org/10.1097%2F00004836-199903000-00008
8.
Pandolfino JP, Kwiatek MA, Nealis T, Bulsiewicz W, Post J, Kahrias PJ: Achalasia: a new clinically relevant classification by high-resolution manometry. Gastroenterol 2008;135:1526–1533.
[PubMed]
https://doi.org/10.1053%2Fj.gastro.2008.07.022
9.
Ghosh SK, Pandolfino JE, Rice J, Clarke JO, Kwiatek M, Kahrilas PJ: Impaired deglutitive EGJ relaxation in clinical esophageal manometry: a quantitative analysis of 400 patients and 75 controls. Am J Physiol Gastrointest Liver Physiol 2007;293:G878–G885.
[PubMed]
https://doi.org/10.1152%2Fajpgi.00252.2007
10.
Campos GM, Vittinghoff E, Rabl C, Takata M, Gadenstatter M, Lin F, Ciovica R: Endoscopic and surgical treatments for achalasia: a systematic review and meta-analysis. Ann Surg 2009;249:45–57.
[PubMed]
https://doi.org/10.1097%2FSLA.0b013e31818e43ab
11.
Farhoomand K, Connor JT, Richter JE, Achkar E, Vaezi MF: Predictors of outcome of pneumatic dilation in achalasia. Clin Gastroenterol Hepatol 2004;2:389–394.
[PubMed]
https://doi.org/10.1016%2FS1542-3565%2804%2900123-5
12.
Eckardt VF, Gockel I, Bernbard G: Pneumatic dilation for achalasia: late results of a prospective follow up investigation. Gut 2004;53:629–633.
[PubMed]
https://doi.org/10.1136%2Fgut.2003.029298
13.
Howard JM, Mongan AM, Manning BJ, Byrne P, Lawler P, Ravi N, Reynolds JV: Outcomes in achalasia from a surgical unit where pneumatic dilation is first-line therapy. Dis Esophagus 2010;23:465–472.
[PubMed]
https://doi.org/10.1111%2Fj.1442-2050.2010.01055.x
14.
Vela MF, Richter JE, Khandwala F, Blackstone EH, Wachsberger D, Baker ME, Rice TW: The long-term efficacy of pneumatic dilatation and Heller myotomy for the treatment of achalasia. Clin Gastroenterol Hepatol 2006;4:580–587.
[PubMed]
https://doi.org/10.1016%2FS1542-3565%2805%2900986-9
15.
Wehrmann T, Jacobi V, Jung M, Lembcke B, Caspary W: Pneumatic dilation in achalasia with a low-compliance balloon: results of a 5-year prospective evaluation. Gastrointestinal Endosc 1995;42:31–36.
[PubMed]
https://doi.org/10.1016%2FS0016-5107%2895%2970239-3
16.
Kadakia S, Wong R: Graded pneumatic dilatation using Rigiflex achalasia dilators in patients with primary esophageal achalasia. Am J Gastroenterol 1993;88:34–38.
[PubMed]
17.
Penagini R, Cantu P, Mangano M, Colombo P, Bianchi PA: Long-term effect of pneumatic dilation on symptoms and lower oesophageal sphincter pressure in achalasia. Scand J Gastroenterol 2002;37:380–384.
[PubMed]
https://doi.org/10.1080%2F003655202317315980
18.
Bravi I, Nicita MT, Duca P, Grigolon A, Cantu P, Caparello C, Penagini R: A pneumatic dilation strategy in achalasia: prospective outcome and effects on oesophageal motor function in the long term. Aliment Pharmacol Ther 2010;31:658–665.
[PubMed]
https://doi.org/10.1111%2Fj.1365-2036.2009.04217.x
© 2013 S. Karger AG, Basel
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
2013
You do not currently have access to this content.