Oesophagitis is common in patients with achalasia after pneumatic dilatation
Article first published online: 30 MAR 2006
Alimentary Pharmacology & Therapeutics
Volume 23, Issue 8, pages 1197–1203, April 2006
How to Cite
LEEUWENBURGH, I., VAN DEKKEN, H., SCHOLTEN, P., HANSEN, B. E., HARINGSMA, J., SIERSEMA, P. D. and KUIPERS, E. J. (2006), Oesophagitis is common in patients with achalasia after pneumatic dilatation. Alimentary Pharmacology & Therapeutics, 23: 1197–1203. doi: 10.1111/j.1365-2036.2006.02871.x
- Issue published online: 30 MAR 2006
- Article first published online: 30 MAR 2006
- Publication data Submitted 9 August 2005 First decision 19 September 2005 Resubmitted 23 November 2005 Accepted 23 December 2005
Background Achalasia, an oesophageal motor disease, is associated with functional oesophageal obstruction. Food stasis can predispose for oesophagitis. Treatment aims at lowering of the lower oesophageal sphincter pressure, enhancing the risk of gastro-oesophageal reflux. Nevertheless, the incidence of oesophagitis after achalasia treatment is unknown.
Aim To investigate the incidence and severity of oesophagitis in achalasia patients treated with pneumatic dilatation.
Methods A cohort of 331 patients with achalasia were treated with pneumatic dilatation and followed. Oesophagitis and stasis were assessed by endoscopy and inflammation was graded by histology.
Results 251 patients were followed for a mean values of 8.4 years (range: 1–26). The average number of endoscopies with biopsy sample sets per patient was 4 (range: 1–17). Three patients had no histological signs of oesophagitis throughout follow-up, 139 had oesophagitis grade 1, 49 oesophagitis grade 2 and 60 grade 3. Specialized intestinal metaplasia was found in 37 patients. The association between endoscopic food stasis and histological inflammation was significant. The association between endoscopic signs of oesophagitis and histological inflammation was poor.
Conclusions Forty percent of the achalasia patients develop chronic active or ulcerating oesophagitis after treatment. Inflammation was associated with food stasis. Because the sensitivity of endoscopy to detect inflammation is low, surveillance endoscopy with biopsy sampling and assessment of stasis is warranted to detect early neoplastic changes.