Jb. Marshall et al., SUPINE AND UPRIGHT RADIONUCLIDE ESOPHAGEAL TRANSIT BEFORE AND AFTER TREATMENT FOR ACHALASIA, Clinical nuclear medicine, 19(8), 1994, pp. 683-686
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.