ESOPHAGEAL FUNCTION IN ACHALASIA - PREOPERATIVE AND POSTOPERATIVE MANOMETRIC STUDIES

Background/Purpose: Aperistalsis observed in children with achalasia m ay be secondary to sphincteric spasm or reflect a primary esophageal d ysfunction. The aim of this study was to assess manometrically sphinct eric function and esophageal motility before and after successful myot omy. Methods: Conventional stationary and pull-through manometry were performed preoperatively in 14 patients and postoperatively in 13. Amb ulatory 24-hour manometry was carried out in four and eight patients i n these two groups, respectively, and the results were compared with t hose of 23 refluxing youngsters. Results: Sphincter hypertony with lac k or incompleteness of relaxation was found preoperatively in all pati ents, and sphincter pressure decreased dramatically after myotomy in a ll of them. All patients had aperistalsis preoperatively, and only a f ew had some primary, but weak, contractions postoperatively. Ambulator y manometry results confirmed a reduced number of motor events even du ring meals and only insignificant improvement of progressiveness, comp leteness and amplitude of waves after myotomy irrespective of the time elapsed since the procedure, the degree of recovery of esophageal cal iber, and the clinical outcome. Conclusions: Motor disorders in achala sia in children are similar to those of adults with the same disease. Motor recovery is observed only in some patients, although it is never complete, and their esophagi will remain ineffective for life. Becaus e myotomy destroys the sphincter, and motility is permanently impaired in this condition, a fundoplication must be interposed to allow long- term mucosal protection. Copyright (C) 1998 by W.B. Saunders Company.