SUPINE AND UPRIGHT RADIONUCLIDE ESOPHAGEAL TRANSIT BEFORE AND AFTER TREATMENT FOR ACHALASIA

The authors hypothesized that radionuclide esophageal transit (RET) st udies performed in the upright position and aided by gravity would pro vide better objective evaluation of achalasia than supine scanning and would correlate better with the degree of symptomatic relief after tr eatment. Radionuclide esophageal transit studies were prospectively pe rformed in both the supine and upright positions in four symptomatic p atients before treatment, after simple dilation, and after pneumatic d ilation in patients who did not respond to simple dilation. After simp le dilation, two patients reported near resolution of symptoms. Supine RET revealed little improvement, but upright esophageal emptying was markedly improved at 2, 5, and 10 minutes. In the two patients who had no relief after simple dilation, RET failed to show improvement while they were in either the supine or the upright position. These patient s subsequently underwent pneumatic dilation that resulted in resolutio n of symptoms and marked improvement in upright RET only. In the supin e position, the esophageal emptying at 2 minutes in the four patients after successful dilation improved from 0% baseline to a mean of 14% ( +/-18%). However, in the upright position, esophageal emptying improve d from 3% (+/-3%) to 73% (+/-17%) and better correlated with symptomat ic relief. The difference in improvement in esophageal emptying in the upright versus the supine position was statistically significant (P = 0.0033). The authors conclude that only upright esophageal emptying p rovides objective evidence that correlates well with symptomatic relie f. Based on the authors' early experience, patients who had good sympt omatic relief from treatment exhibited greater-than-or-equal-to 50% (5 0-95%) esophageal emptying at 2 minutes when scanned upright after hav ing a liquid meal.