Research Article
Viviane Fittipaldi ,Gerson Ric
Abstract
Background: Achalasia is classified by high-resolution manometry into three subtypes, which are proposed to predict clinical outcome. Goals: The aim of this prospective study was to evaluate the clinical outcomes of achalasia subtypes after pneumatic dilation, their manometric and radiologic features. Study: Fifty three achalasia patients were enrolled. The clinical characteristics, the Eckardt score, radiological and manometric variables were collected and analyzed. Patients were treated with pneumatic dilation. Results: Of the 53 patients, 07 (13%) were classified as subtype I, 44 (83%) as subtype II, and 2 (4%) as subtype III. Clinical response among the subtypes were similar: 7/7 (100%) subtype I, 39/44 (88, 64%) subtype II and 2/2 (100%) subtype III. Forty-four patients were submitted to pre- and post-treatment high-resolution manometry. The integrated relaxation pressure and the basal respiratory pressure of the lower esophageal sphincter were significantly lower after the treatment (p<0,001), with a similar decrease between subtypes I and II (p=0,494 and p=0,608, respectively). Logistic regression analysis found that elevated integrated relaxation pressure and basal respiratory pressure of the lower esophageal sphincter were associated with high integrated relaxation pressure after pneumatic dilation (OR 1.13 and 1.04, respectively). Barium column height, at timed barium esophagram , at minute 5 was higher than 5 cm in 18/27 (66.6%) patients with clinical response and in 2/3 (66.6%) patients without clinical response (p=1.00). Conclusion: No difference in clinical response to pneumatic dilation was observed among the 3 subtypes. Barium column height and the manometric features studied were not related with clinical outcome.