Médecine interne: libre accès
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Abstrait

Subtypes of Achalasia Do Not Predict the Clinical Response of Pneumatic

Viviane Fittipaldi ,Gerson Ricardo de Souza Domingues , Ana Teresa Pugas Carvalho , Rodrigo Sperling Torezani,Joaquim Prado Pinto de Moraes Filho, Hugo Perazzo Pedroso Barbosa

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.

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-treatmenthigh-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.