Original Scientific Articles
Manometric and radiographic verification of esophageal body decompensation for patients with achalasia1

https://doi.org/10.1016/S1072-7515(99)00091-5Get rights and content

Abstract

Background: Although morphologic, radiographic, and manometric features of achalasia have been well defined, it has not been established by careful retrospective analysis whether achalasia is a progressive disorder resulting in complete decompensation.

Study Design: To verify the hypothesis that achalasia is a progressive disease, we retrospectively investigated manometric, radiographic, and symptomatic data in patients with achalasia. Sixty-three patients (36 women and 27 men) with a median age of 44 years (range 11 to 79 years) were evaluated. The duration of symptoms ranged from 1 to 442 months, with a median of 48 months. Patients were divided into four groups according to the duration of symptoms: 36 patients with less than 5 years, 11 with 5 to 10 years, 9 with 10 to 15 years, and 7 with 15 years or more.

Results: Contraction pressures of the esophageal body decreased significantly at every level when the duration of symptoms increased (p < 0.04). The percentage of simultaneous waves in the esophageal body rose as the duration of symptoms increased. All waves were synchronous in every patient who had had symptoms for more than 15 years. The maximal width of the esophageal body measured on esophagram became greater with an increase in the duration of symptoms, but this measurement did not reach statistical significance (p = 0.063). The tortuosity of the esophagus, measured by the maximal angle of the esophageal axis, was significantly greater in patients with a longer duration of symptoms (p < 0.02). The type of symptoms was not associated with the duration of symptoms.

Conclusions: Achalasia is a progressive disease, as verified by manometric and radiographic findings. The classification of esophageal motor function expressed by amplitude of contraction pressure and angle of tortuosity is objective and useful. Classification of achalasia by duration of symptoms may be important in treatment selection and effectiveness.

Section snippets

Methods

Sixty-three patients (36 women and 27 men) with a median age of 44 years (range 11 to 79 years) were evaluated. All patients underwent manometry and most patients had a barium swallow to establish the diagnosis of achalasia. The duration of symptoms ranged from 1 to 442 months, with a median of 48 months. Patients were divided into four groups according to the duration of symptoms: 36 patients with less than 5 years, 11 with 5 to 10 years, 9 with 10 to 15 years, and 7 with 15 years or more.

Results

Differences in age at the time of clinic visit, age of onset, gender, and weight among the groups categorized by the duration of symptoms are shown in Table 1. There was no difference in gender or weight among the groups. The median age at clinic visit for patients with a symptom duration of less than 5 years was significantly younger. There was no significant difference in age of onset.

The average resting pressure of the LES, measured by manometry, in patients experiencing symptoms for less

Discussion

It is commonly accepted that achalasia is a progressive disorder. In this investigation of four groups of patients categorized by duration of symptoms (patient gender, weight, age at onset, and diagnosis were equivalent among groups, as established by the Kruskal-Wallis test), we objectively confirmed by both manometric and radiographic data the progressive nature of achalasia. We also demonstrated for the first time that contraction pressure at each level of the esophageal body was weaker in

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    No competing interests declared.

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