Original Contribution
The American Journal of Gastroenterology (2004) 99, 2304–2310; doi:10.1111/j.1572-0241.2004.40099.x
Long-Term Follow-Up after Pneumatic Dilation for Achalasia Cardia: Factors Associated with Treatment Failure and Recurrence
This paper was presented at the presidential paper session of the Asia Pacific Digestive Disease Week, September 2003 in Singapore.
UC Ghoshal MD, DM1, S Kumar MD, DM1, VA Saraswat MD, DM1, R Aggarwal MD, DM1, A Misra PhD1 and G Choudhuri MD, DM1
1Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow 226014, India
Correspondence: UC Ghoshal, Assistant Professor, Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
Received 5 June 2004; Revised 0000; Accepted 1 July 2004.
Abstract
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 (
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, 
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.
