Long-term follow-up after pneumatic dilation for achalasia cardia: factors associated with treatment failure and recurrence.

Ghoshal, U. C. ; Kumar, S. ; Saraswat, V. A. ; Aggarwal, R. ; Misra, A. ; Choudhuri, G. (2004) Long-term follow-up after pneumatic dilation for achalasia cardia: factors associated with treatment failure and recurrence. American Journal of Gastroenterology, 99 (12). pp. 2304-2310. ISSN 0002-9270

Full text not available from this repository.

Official URL: http://www.nature.com/ajg/journal/v99/n12/full/ajg...

Related URL: http://dx.doi.org/10.1111/j.1572-0241.2004.40099.x


Background: Though most patients with achalasia cardia (AC) respond to pneumatic dilation (PD), one-third experienced recurrence. Long-term follow-up studies on factors associated with various outcomes are scanty. Methods: In this retrospective study, 126 patients (36.5 +/- 14.6 yr, 76 male) with AC (diagnosed by esophagoscopy, barium esophagogram, and/or manometry) were followed up in person or through mail. The median dysphagia-free duration was calculated by Kaplan-Meier analysis. Factors associated with nonresponse and recurrence after PD were determined using univariate and multivariate analyses. Results: Symptoms were dysphagia (126, 100%), chest pain (21, 17%), regurgitation (61, 48%), weight loss (33, 26%), and pulmonary symptoms (23, 18%); 5 of 126 (4%) had megaesophagus (> or =7 cm). The mean lower esophageal sphincter (LES) pressure was 38.7 +/- 16.8 mmHg. One hundred and fifteen of 126 (91%) patients responded to PD (90 (71%) to first session); 25 of these had recurrence of dysphagia after 15 +/- 17 months. Post-PD chest pain requiring hospitalization occurred in 21 of 126 (17%; one had an esophageal perforation). Post-PD LES pressure, which was assessed in 48 of 126 patients, had decreased by >50% from baseline in 14 of 29 responders, 0 of 11 nonresponders (p= 0.004, chi(2) test), and 5 of 8 relapsers. The median dysphagia-free duration by Kaplan-Meier analysis was 60 months (SE 2.7, 95% CI 54.7-65.3). On univariate analysis, male gender, pulmonary symptoms (nocturnal coughing spell, history of respiratory infection), absence of chest pain, and failure to achieve a reduction in LES pressure >50% after PD were associated with poor outcome; whereas age, grade of dysphagia, regurgitation, megaesophagus, and LES pressure before PD were not. Male gender was associated with poor outcome by multivariate-analysis. Conclusions: PD is an effective and safe treatment for AC. Post-PD LES pressure measurement may be helpful in assessing response. Male patients have poorer outcomes following PD.

Item Type:Article
Source:Copyright of this article belongs to Nature Publishing Group.
ID Code:94609
Deposited On:18 Oct 2012 07:30
Last Modified:18 Oct 2012 07:30

Repository Staff Only: item control page