This prospective population based study was designed to evaluate treatment choices in patients with manometrically diagnosed achalasia and their outcome.
In this research ethics board approved study, consenting patients referred to esophageal function laboratory were enrolled after manometric diagnosis of achalasia. Patients completed an initial validated questionnaire on their symptom severity, duration, treatment pre-diagnosis and Medical Outcomes Study 36-item Short-Form survey. Subsequent treatment was left to the referring physician and patients were mailed a questionnaire every 3 months for 1 year.
Between January 2004 and January 2005, 83 patients were enrolled with a median symptom duration of 2-5 years. Heller myotomy was performed on 31(36.0%) patients, 3(3.6%) received botulinum toxin injections, and 25 (29.7%) patients received 29 dilatations, while 25(29.1%) patients did not have any invasive treatment. Following treatment, patients treated with surgery, dilatation and botulinum toxin had an average improvement in achalasia symptom score of 23+/-12.2, 17+/-10.9 and 9+/-14, respectively. Patients receiving no treatment had worsening symptoms with a symptom score change of –3.5+/-11.4. Surgery and dilatation resulted in significant improvement (p<0.01) relative to no treatment. In univariate logistic regression, symptom severity score (OR 1.04, 95% CI 1.00 to 1.08), sphincter tone (1.04, 95% CI 1.00 to 1.09), difficulty swallowing liquids (OR 3.21, 95% 1.15 to 8.99), waking from sleep(OR 2.75, 95% 1.00 to 7.61), and weight loss(OR 5.99, 95% CI 1.93 to 18.58), were all significant in predicting that patients would have treatment. In the multivariate analysis, increasing age (OR 1.05, 95% CI 1.01 to 1.09) and weight loss (OR 3.91 95% CI 1.02 to 15.2) were statistically significant for undergoing treatment.
This study shows that almost one third of patients with manometrically diagnosed achalasia do not undergo treatment within one year. Patients who are more symptomatic appear to be more likely to undergo treatment in univariate analysis. In multivariate analysis, increasing age and weight loss are predictive of those who will undergo treatment, with weight loss having the greatest influence.
Program Number: P288