ESOPHAGEAL ACHALASIA WITH APPARENT NORMAL LOWER ESOPHAGEAL SPHINCTER RELAXATION - CLINICAL RELEVANCE AND RESPONSE TO PNEUMATIC DILATION

Objective: To evaluate if the clinical presentation and the response t o pneumatic dilation is different in patients with achalasia with an a pparent normal lower esophageal sphincter relaxation. Design: Prospect ive study to compare clinical, radiographic and manometric characteris tics and the response to pneumatic dilation according to the ability o f the lower esophageal sphincter to relax normally. Patients: One hund red and fifty seven consecutive patients with achalasia were included. Relaxation of the lower esophageal sphincter was abnormal in 130 pati ents and apparently normal in 27. The response to pneumatic dilation w as evaluated in 116 patients, 94 with abnormal function of the lower e sophageal sphincter and 22 with normal function. Results: Clinical fin dings, esophageal diameter and basal pressure of the lower esophageal sphincter were similar in both groups. The efficacy of the dilation, t he number of dilations and the rate of complications were also similar . Conclusions: Patients with achalasia and an apparent normal lower es ophageal sphincter relaxation are not different from patients with typ ical achalasia and present a similar response to pneumatic dilation.