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Residual lower esophageal sphincter pressure as a prognostic factor in the pneumatic balloon treatment of achalasia
Author(s) -
Park Jung Ho,
Lee Yong Chan,
Lee Hyuk,
Park Hyojin,
Youn Young Hoon,
Park Hyung Seok,
Lee Tae Hee,
Hong Kyoung Sup
Publication year - 2015
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.12642
Subject(s) - medicine , achalasia , confidence interval , esophageal sphincter , odds ratio , surgery , dysphagia , balloon , swallowing , gastroenterology , esophagus , reflux , disease
Abstract Background and Aims Pneumatic balloon dilatation ( PD ) is a mainstay in achalasia treatment. The aim of this study was to identify predictive factors for successful treatment. Methods We retrospectively reviewed 76 patients with a diagnosis of achalasia who underwent PD from J une 2010 to M ay 2013. Clinical symptoms were assessed using E ckardt score and manometry data were analyzed using resting and relaxation pressure (4s IRP ) of lower esophageal sphincter ( LES ) and the distal contractile integral ( DCI ), which was calculated for 10 s from the start of deglutition between the upper margin of the LES and lower margin of upper esophageal contraction. Patients with achalasia were classified into three groups based on the Chicago classification. Results Among 76 patients, 52 patients received PD , and the treatment was unsuccessful in 9 patients (6 in class I and 3 in class III ). When comparing prognostic factors between successful and unsuccessful treatment groups, the mean value for 4s IRP in the unsuccessful treatment group was significantly lower than that in the successful treatment group ( P < 0.05). However, no difference was noticed in resting LES pressure, DCI , age, and sex. Furthermore, a lower mean value of 4s IRP was significantly related to unsuccessful treatment of achalasia (odds ratio, 1.092; 95% confidence interval, 1.001–1.191) even after adjustment for a series of confounding factors. Conclusions Lower 4s IRP may be a prognostic indicator for poor treatment outcome after PD .