PATHOLOGICAL ESOPHAGEAL ACIDIFICATION AND PNEUMATIC DILATATION IN ACHALASIC PATIENTS - TOO MUCH OR NOT ENOUGH

Endoscopy, esophageal manometry and pH monitoring, gastric emptying te st, and heartburn quantification on a visual analog scale were perform ed in 22 achalasic patients in order to clarify which events are assoc iated with pathological esophageal acidification after successful LES dilatation. Five patients presented pathological acidification. Dilata tion reduced LES tone from 38.3 +/- 4.2 to 14.6 +/- 1.1 mm Hg (mean +/ - SEM); there was, however, no difference between nonrefluxers and ref luxers (14.8 +/- 1.2 vs 13.8 +/- 2.5 mm Hg). The emptying time in acha lasic patients was delayed compared to controls (315.9 +/- 20.9 min vs 209 +/- 10.4) due to prolonged lag-phase and reduced slope of the ant ral section-time curve, but, again, there was no difference between re fluxers and nonrefluxers. The acid clearance was delayed in refluxers compared to nonrefluxers (15.9 +/- 4.5 vs 2.5 +/- 1.8 min, P < 0.05). Two refluxers presented grade 1 esophagitis; one of them developed an esophageal ulcer. The heartburn score was the same in refluxers and no nrefluxers. Pathological acidification after pneumatic dilatation is a ssociated with persistent problems in esophageal emptying rather than with excessive sphincter divulsion.