IATROGENIC ACHALASIA - A CASE SERIES

Between 1984 and 1992, 14 cases of ''secondary'' achalasia were diagno sed at our institution, five due to malignancy and nine as a result of esophageal or paraesophageal surgery. Preoperative manometry had excl uded preexistent achalasia in eight of nine of the latter patients. Dy sphagia developed immediately postoperatively in all. Esophagram and s ubsequent manometry were consistent with achalasia. All failed convent ional dilation sessions and eight of nine underwent pneumatic dilation : Five were cured by this alone, two required surgery (one for iatroge nic perforation), and one was lost to follow-up. This achalasia-like p icture appears to be the result of a tight antireflux repair that impa irs the ability of the lower esophageal sphincter to completely relax, creating a functional obstruction with proximal dilation and stasis. Such secondary achalasia appears to be a distinct clinical entity and was more common than that associated with neoplasia in our institution . Therapeutically, pneumatic dilation was required and probably causes partial disruption of a tight surgical repair.