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Paper Information

Journal:   GOVARESH JOURNAL   FALL 2015 , Volume 20 , Number SUPPLEMENT; Page(s) 23 To 23.
 
Paper: 

MANOMETRIC ACHALASIA SUBTYPES; FREQUENCY AND RESPONSE TO TREATMENT IN OUR PATIENTS

 
 
Author(s):  MIKAELI JAVAD*, ASL SOLEIMNI HOSSEIN, FAZLOLLAHI NARGES, KHOSRAVI PEJMAN, MALEKZADEH REZA
 
* DIGESTIVE DISEASE RESEARCH INSTITUTE,TEHRAN UNIVERSITY OF MEDICAL SCIENCES
 
Abstract: 

Introduction: High resolution manometry (HRM) is the gold standard for the diagnosis of achalasia. Three manometric patterns are seen in HRM. AIM: To investigate the frequency and response to treatment in subtypes of achalasia.
Methods: 148 patients with idiopathic achalasia (IA) were evaluated prospectively. HRM was performed for the patients before treatment, categorizing them in three groups. The patients were treated with pneumatic balloon dilation (PBD), and evaluated before and six weeks after PBD with achalasia symptom score (ASS) and Timed barium esophagogram (TBE) and then every six months with ASS. Primary outcome was defined as a decrease in ASS (?4) and a reduction (80%?) in the volume of barium in TBE in six weeks.
Results: According to HRM, 29 patients were classified as type I (19.5%), 99 as type II (67%) and 20 as type III (13.5%). The mean LES resting pressure values before treatment were 31.64, 32.65 and 36.67 mmHg in types I, II and III, respectively (P=0.57).19 patients in type I (65%), 87 patients in type II (87%) and 15 patients in type III (75%) had good primary outcome and this response was significantly better in type II compared to type I (P=0.020). Patients with type III had the earliest relapses (mean: 8.39 months) (P=0.045). Finally, 13patients in type I (45%), 60 patients in type II (60%) and 11 patients in type III (55%) revealed sustained good response (P=0.92).
Conclusion: According to HRM, type II is the most common type of IA. In this study, no significant differences were seen between the three subtypes of achalasia in terms of LES resting pressure and ASS before treatment, as well as the response to treatment except for good primary outcome between type I and II, while the mean relapse time was significantly shorter in type III.

 
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