Evaluation of clinical characteristics and lower esophageal sphincter pressure on high resolution manometry in achalasia patients after treatment

Abstract

Objective: to describe the clinical characteristics and lower esophageal sphincter (LES) pressures on highresolution manometry (HRM) in patients with achalasia pre- and post-treatment. Methods: a case series study was conducted in achalasia patients. Clinical symptoms, Eckardt score, upper gastrointestinal endoscopy, esophageal barium swallow, and HRM results were collected on baseline and Eckardt score and HRM results on follow-up were collected. Results: from June 2018 to December 2019, 14 patients were recruited including 6 males and 8 females with mean age of 34.6±10.5 y. The proportion of achalasia type I, II, and III were 28.6, 64.3, and 7.1%, respectively. The Eckardt score, LES resting pressure (for both baseline period and swallow phase) and 4-s integrated resting pressure (IRP4s) significantly decreased after treatment (p<0.05). There was a correlation between pre-treatment LES resting pressure (in swallow phase) and change in chest pain score (p=0.044, r=0.546) and a correlation between pre-treatment IRP4s and change in Eckardt score (p=0.041, r=0.549). IRP4s had no significant difference between treatment success and recurrence groups. After treatment, 11 patients had clinical success and 3 patients recurred/failed after a median of 4 mo. The diagnosis on HRM after treatment included 5 achalasia (4 type I and 1 type II), 1 esophagogastric junction outflow obstruction (EGJOO), 1 distal esophageal spasm (DES), 6 absent contractility, and 1 ineffective esophageal motility (IEM). Conclusion: Eckardt score, LES pressure, and IRP4s improved significantly after treatment. Besides the role of classification and treatment option, HRM could be used to predict the treatment outcome in achalasia.

Keywords

• achalasia
• high resolution manometry (HRM)
• lower esophageal sphinte
• treatment