Comparison of the clinical features and effect of pneumatic balloon dilatation for classic and vigorous achalasia

Lee, Dong Hyun; Kim, Ji Young; Park, Jung Lae; Heo, Jeong Ho; Bae, Yong Mock; Jeong, Eul Jo; Kim, Gwang Ha; Kang, Dae Hwan; Song, Keun Am; Cho, Mong; Yang, Ung Suk

Abstract

BACKGROUND: Compared with classic achalasia, vigorous achalasia has been defined as achalasia with relatively high esophageal contraction amplitudes, often with minimal esophageal dilation and prominent tertiary contractions on radiographs and the presence of chest pain. The lesser success of pneumatic balloon dilation, also, has been reported for the subset with vigorous achalasia. Nevertheless, some authors have questioned the usefulness of making this distinction. We evaluated the difference of clinical manifestations and response to pneumatic balloon dilation between classic and vigorous achalaisia.
METHODS
28 cases involving patients with achalasia who underwent balloon dilation treatment were available for the review of their clinical findings, radiographic, manometric, esophageal scintigraphic parameters. Patients with vigorous achalasia [n=10] were defined by contraction amplitude >or=37 mmHg on esophageal manometry and patients with classic achalasia [n=18] as contraction amplitude <37 mmHg.
RESULTS
Both groups of patients had substantial overlap in clinical findings, radiographic, manometric and esophageal scintigraphic parameters. The success rates of balloon dilation, also, were similar for both groups (classic vs vigorous, 78% vs 70%).
CONCLUSION
It is concluded that the distiction of achalasia as classic and vigorous by an amplitude criterion is arbitrary and not useful.