Manometric and radiographic verification of esophageal body decompensationfor patients with achalasia

Background: Although morphologic, radiographic, and manometric features of achalasia have been well defined, it has not been established by careful re trospective analysis whether achalasia is a progressive disorder resulting in complete decompensation. Study Design: To verify the hypothesis that achalasia is a progressive dise ase, we retrospectively investigated manometric, radiographic, and symptoma tic data in patients with achalasia. Sixty-three patients (36 women and 27 men) with a median age of 44 years (range 11 to 79 years) were evaluated. T he duration of symptoms ranged from 1 to 442 months, with a median of 48 mo nths. Patients were divided into four groups according to the duration of s ymptoms: 36 patients with less than 5 years, 11 with 5 to 10 years, 9 with 10 to 15 years, and 7 with 15 years or more. Results: Contraction pressures of the esophageal body decreased significant ly at every level when the duration of symptoms increased (p < 0.04). The p ercentage of simultaneous waves in the esophageal body rose as the duration of symptoms increased. All waves were synchronous in every patient who had had symptoms for more than 15 years. The maximal width of the esophageal b ody measured on esophagram became greater with an increase in the duration of symptoms, but this measurement did not reach statistical significance (p 0.063). The tortuosity of the esophagus, measured by the maximal angle of the esophageal axis, was significantly greater in patients with a longer du ration of symptoms (p < 0.02). The type of symptoms was not associated with the duration of symptoms. Conclusions: Achalasia is a progressive disease, as verified by manometric and radiographic findings. The classification of esophageal motor function expressed by amplitude of contraction pressure and angle of tortuosity is o bjective and useful. Classification of achalasia by duration of symptoms ma y be important in treatment selection and-effectiveness. (J Am Coll Surg 19 99;189: 158-163. (C) 1999 by the American College of Surgeons).