A PROSPECTIVE ASSESSMENT OF GASTROESOPHAGEAL REFLUX BEFORE AND AFTER TREATMENT OF ACHALASIA PATIENTS - PNEUMATIC DILATION VERSUS TRANSTHORACIC LIMITED MYOTOMY

Objectives: We conducted this study to determine whether reflux should be a major consideration in the choice of treatment for achalasia pat ients. Achalasia patients undergoing either pneumatic dilation or tran sthoracic limited esophagomyotomy were monitored for reflux before and after treatment, for comparison. Methods: Twenty-four hour ambulatory esophageal pH tests and esophageal manometry were performed on 32 con secutive, untreated achalasia patients. Studied (before and after trea tment) were 17 patients who underwent pneumatic dilation and 15 patien ts who received transthoracic limited myotomy without fundoplication. All follow-up studies were completed within 12 months of treatment. Re sults: The ages of the two groups were not significantly different (p > 0.05, 45 +/- 9 yr myotomy vs. 44 +/- 13 yr dilation). The resting lo wer esophageal sphincter pressure was not significantly different (p > 0.05 before treatment) between groups but was reduced significantly ( p < 0.05 after treatment) in both groups (30 +/- 9 mm Hg before vs. 9 +/- 4 mm Hg after myotomy, and 27 +/- 10 mm Hg before vs. 11 +/- 4 mm Hg after pneumatic dilation. The total time the pH was <4.0 was not si gnificantly different, p > 0.05, in either group before treatment (myo tomy, 3.7 +/- 4.4%; dilation, 2.9 +/- 4.9%) or after treatment (myotom y, 8.6 +/- 9.2%; dilation, 10.2 +/- 15.9%). Twelve of 32 patients (38% ), had a percent total time <4.0 that exceeded 6% after treatment, eig ht of whom were asymptomatic. Conclusions: These results indicate that the amount of reflux after treatment by both pneumatic dilation and t ransthoracic esophagomyotomy is similar. The absence of reflux symptom s in treated achalasia patients does not exclude the possibility of si gnificant acid reflux.