Achalasia: the Usefulness of Manometry for Evaluation of Treatment

Overview

Journal Dig Dis Sci

Specialty Gastroenterology

Date 1999 Mar 18

PMID 10080146

Citations 5

Authors

P Alonso

B Gonzalez-Conde

R Macenlle

S Pita

J L Vazquez-Iglesias

Affiliations

Soon will be listed here.

Abstract

Although manometry is used with increasing frequency to evaluate the effectiveness of different treatments for achalasia, the criteria for a successful manometric response have not been well defined. Manometric responses were collected before and after 43 treatments in 35 patients with achalasia in order to determine manometric changes after different clinical outcomes: 15 unsuccessful outcomes and 28 successful outcomes were reported. In the latter, resting pressure of the lower esophageal sphincter decreased to 12.8 mm Hg, whereas in unsuccessful outcomes this was significantly higher (28.2 mm Hg). A decrease of lower esophageal sphincter pressure below 17 mm Hg or more than 40% of the pretreatment level was associated with successful outcomes. Our data suggest that manometry is a good indicator of therapeutic effectiveness and we propose that it be used systematically for objective evaluation of achalasia treatment.

Citing Articles

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References

VANTRAPPEN G, Hellemans J, Deloof W, Valembois P, Vandenbroucke J . Treatment of achalasia with pneumatic dilatations. Gut. 1971; 12(4):268-75. PMC: 1411631. DOI: 10.1136/gut.12.4.268. View

Parrilla Paricio P, Martinez de Haro L, Ortiz A, Aguayo J . Achalasia of the cardia: long-term results of oesophagomyotomy and posterior partial fundoplication. Br J Surg. 1990; 77(12):1371-4. DOI: 10.1002/bjs.1800771217. View

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. Gastrointest Endosc. 1995; 42(1):31-6. DOI: 10.1016/s0016-5107(95)70239-3. View

Csendes A . Results of surgical treatment of achalasia of the esophagus. Hepatogastroenterology. 1991; 38(6):474-80. View

Kadakia S, Wong R . Graded pneumatic dilation using Rigiflex achalasia dilators in patients with primary esophageal achalasia. Am J Gastroenterol. 1993; 88(1):34-8. View

Ott D, Richter J, Wu W, Chen Y, Castell D, Gelfand D . Radiographic evaluation of esophagus immediately after pneumatic dilatation for achalasia. Dig Dis Sci. 1987; 32(9):962-7. DOI: 10.1007/BF01297184. View

Streitz Jr J, ELLIS Jr F, WILLIAMSON W, Glick M, Aas J, Tilden R . Objective assessment of gastroesophageal reflux after short esophagomyotomy for achalasia with the use of manometry and pH monitoring. J Thorac Cardiovasc Surg. 1996; 111(1):107-12; discussion 112-3. DOI: 10.1016/S0022-5223(96)70406-3. View

GELFAND M, Kozarek R . An experience with polyethylene balloons for pneumatic dilation in achalasia. Am J Gastroenterol. 1989; 84(8):924-7. View

Lee J, Cecil B, BROWN P, Wright R . The Cohen test does not predict outcome in achalasia after pneumatic dilation. Gastrointest Endosc. 1993; 39(2):157-60. DOI: 10.1016/s0016-5107(93)70056-5. View

10.

Benini L, Sembenini C, Castellani G, Bardelli E, Brentegani M, Giorgetti P . Pathological esophageal acidification and pneumatic dilitation in achalasic patients. Too much or not enough?. Dig Dis Sci. 1996; 41(2):365-71. DOI: 10.1007/BF02093830. View

11.

Little A, Soriano A, Ferguson M, Winans C, SKINNER D . Surgical treatment of achalasia: results with esophagomyotomy and Belsey repair. Ann Thorac Surg. 1988; 45(5):489-94. DOI: 10.1016/s0003-4975(10)64520-1. View

12.

Csendes A, Braghetto I, Mascaro J, Henriquez A . Late subjective and objective evaluation of the results of esophagomyotomy in 100 patients with achalasia of the esophagus. Surgery. 1988; 104(3):469-75. View

13.

ELLIS Jr F, CROZIER R, WATKINS Jr E . Operation for esophageal achalasia. Results of esophagomyotomy without an antireflux operation. J Thorac Cardiovasc Surg. 1984; 88(3):344-51. View

14.

Pandolfo N, Bortolotti M, Spigno L, Bozzano P, Mattioli F . Manometric assessment of Heller-Dor operation for esophageal achalasia. Hepatogastroenterology. 1996; 43(7):160-6. View

15.

Robertson C, Hardy J, Atkinson M . Quantitative assessment of the response to therapy in achalasia of the cardia. Gut. 1989; 30(6):768-73. PMC: 1434143. DOI: 10.1136/gut.30.6.768. View

16.

Parrilla P, Martinez de Haro L, Ortiz A, Morales G, Garay V, Aguilar J . Factors involved in the return of peristalsis in patients with achalasia of the cardia after Heller's myotomy. Am J Gastroenterol. 1995; 90(5):713-7. View

17.

Kim C, Cameron A, Hsu J, Talley N, Trastek V, Pairolero P . Achalasia: prospective evaluation of relationship between lower esophageal sphincter pressure, esophageal transit, and esophageal diameter and symptoms in response to pneumatic dilation. Mayo Clin Proc. 1993; 68(11):1067-73. DOI: 10.1016/s0025-6196(12)60900-8. View

18.

Mearin F, Armengol J, Chicharro L, Papo M, Balboa A, Malagelada J . Forceful dilatation under endoscopic control in the treatment of achalasia: a randomised trial of pneumatic versus metallic dilator. Gut. 1994; 35(10):1360-2. PMC: 1375004. DOI: 10.1136/gut.35.10.1360. View

19.

Duranceau A, Lafontaine E, Vallieres B . Effects of total fundoplication on function of the esophagus after myotomy for achalasia. Am J Surg. 1982; 143(1):22-8. DOI: 10.1016/0002-9610(82)90124-6. View

20.

Jaakkola A, Reinikainen P, Ovaska J, Isolauri J . Barrett's esophagus after cardiomyotomy for esophageal achalasia. Am J Gastroenterol. 1994; 89(2):165-9. View