24-h pH monitoring patterns and clinical response after achalasia treatment with pneumatic dilation or laparoscopic Heller myotomy

Authors

  • P. A. Novais,

    1. Gastroenterology Division, Federal University of Rio de Janeiro, and Clementino Fraga Filho University Hospital, Rio de Janeiro, Brazil.
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  • E. M. O. Lemme

    1. Esophagus Unit of the Gastroenterology Division, Federal University of Rio de Janeiro, and Clementino Fraga Filho University Hospital, Rio de Janeiro, Brazil.
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Dr P. A. Novais, Av. das Américas 3500, Bl 7, Sala 709, Barra da Tijuca, Rio de Janeiro, CEP 22640-102, Brazil.
E-mail: paulanovais@gmail.com

Abstract

Aliment Pharmacol Ther 2010; 32: 1257–1265

Summary

Background  The most effective treatment for achalasia is pneumatic dilation or myotomy. The best option is still controversial and incidence of complications could help choosing. Gastro-oesophageal reflux (GER) is the most frequent complication after treatment for achalasia. The 24-h pH monitoring (24-h pH) is the best method to evaluate true GER.

Aim  To analyse the 24-h pH patterns after treatment, correlating with therapeutic success.

Methods  Untreated patients with achalasia were randomized to pneumatic dilation or laparoscopic Heller myotomy with fundoplication (LHM+Fp) and evaluated with clinical/manometric results and 24-h pH.

Results  Ninety-four patients were analysed pre-treatment and 85 post-treatment. Clinical success was 73.8% in pneumatic dilation group and 88.3% in LHM+Fp group (= 0.08). The incidence of GER was 31% in pneumatic dilation, and 4.7% in LHM+Fp (= 0.001). The occurrence of hypotensive lower oesophageal sphincter (LES) was 53.3% in patients who developed GER and 28.6% in patients with 24-h pH suggesting fermentation (= 0.019). The rates of dysphagia resolution in patients with 24-h pH of GER and fermentation were respectively 86.7% and 85.7% (= 0.89).

Conclusions  True GER 24-h pH is more frequent after pneumatic dilation for achalasia, and it is associated with a hypotensive LES. A 24-h pH suggestive of fermentation or true GER is not associated with worse clinical/manometric results.

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