Article Text

  1. J. A. Wong1,
  2. R. Tatum1
  1. 1University of Washington, Seattle, WA.


Introduction Achalasia is a severe esophageal motility disorder involving a loss of peristalsis and nonrelaxation of the lower esophageal sphincter (LES), resulting in the primary symptom of dysphagia. Manometry combined with Multichannel intraluminal impedance (MII) demonstrates a severe impairment in esophageal bolus clearance in patients with achalasia. Our purpose is to elucidate if manometry/MII can potentially be used in the assessment of achalasia patients after both surgical and nonsurgical treatment in determining the level of improvement in esophageal bolus clearance.

Methods We prospectively performed simultaneous manometry/MII testing on 60 patients referred to the University of Washington Swallowing Center with achalasia between January 2003 and January 2006. Manometric and clinical parameters were used in the diagnosis of achalasia. Esophageal peristalsis and bolus transit rates were compared between patients with primary untreated achalasia, those who had nonsurgical treatment (dilation or botulinum toxin), and a group of patients after Heller myotomy.

Results Thirty-five patients were diagnosed with classic achalasia (group 1), not having had any prior treatment. Ten patients were treated with either balloon dilation or botulinum toxin prior to manometry/MII (group 2), and 15 patients were studied post-Heller myotomy (group 3), yielding a total of 60 patients. Peristalsis for group 1 is 0.88%, for group 2 is 17.91%, and for group 3 is 22.85%. Transit of both liquid and viscous boluses as measured by MII was significantly different between these three groups. The mean liquid bolus transit success rate was 5.43% for group 1, 16.2% for group 2, and 21.92% for group 3. Viscous bolus transit success rate was 2.97% for group 1, 10% for group 2, and 15.38% for group 3. As expected, no patients in any of the three groups were found to have normal bolus transit.

Conclusions From these data we concluded that patients treated prior to manometry/MII readings show a slight restoration in peristalsis as well as improved bolus transit, although still far below normal values. This improvement may explain the relief in dysphagia felt in the majority of these patients. However, MII readings for these individuals still average far below normal values, indicating that bolus transit (as measured by MII) may not account entirely for the relief of dysphagia. Knowing this, MII may be a useful tool in assessing effectiveness of treatment in restoring bolus clearance from the esophagus; however, further evaluation should be done.

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