3723 Quality of life and symptomatic improvement in patients with achalasia: a prospective study.

Abstract

Objective: Treatment for achalasia includes surgical myotomy, pneumatic dilation and injection of botulinum toxin. Success rates range from 32% to 98% and are mostly based on symptomatic improvement. The aim of this study was to evaluate prospectively the symptomatic response and health related quality of life (HRQOL) in patients treated for achalasia. Methods: Eighteen patients with achalasia who presented for treatment were enrolled in the study. Patients completed the Health Status Questionnaire 2.0 (HSQ), a standardized measure of health status, and a symptom questionnaire (SQ) prior to treatment and after an average of 5.2 months follow-up. The SQ (visual analogue scale) measured the severity of dysphagia, regurgitation, chest pain and pressure, cough and heartburn. Symptom scores pre- and post-treatment were compared for all patients. HSQ was analyzed using the Microtest Q Assessment SystemTM. Eight scales describing the components of health status were compared for all patients pre- and post-treatment. Subgroup analyses were done comparing endoscopic versus surgical treatment. Results: To date, 18 patients have completed the follow-up questionnaire. One patient did not complete the HSQ and was excluded from the HSQ analysis. Six patients underwent myotomy, 9 patients had botulinum toxin injection and 3 patients had pneumatic dilation. The average patient age was 56.3 ±17.5 years (range 29-92 years). Ten patients were female (56%). Improvement was noted in patients post-treatment for the following symptoms: dysphagia (mean scores 5.6 pre- and 1.9 post-treatment; p<0.002, t test) and chest pain (mean scores 3.5 pre- and 2.3 post-treatment; p<0.05, t test). Improvement in HRQOL for the social functioning scale was present post-treatment (mean scores 65.4 pre- and 86.8 post-treatment; p<0.01, t test). No significant differences were found in the subgroup analyses for either symptom scores or HRQOL (p<0.05). Discussion: Patients who received endoscopic and surgical treatment for achalasia had significant improvement in dysphagia and chest pain. Improvement in HRQOL on the scale of social functioning was also present. This may be explained by the fact that after treatment patients are able to participate in meals without significant dysphagia or chest pain. Conclusion: This preliminary data shows that treatment for achalasia results in improvement in dysphagia, chest pain and social functioning. Long term study is needed to determine if these improvements are transient or remain present over time. Objective: Treatment for achalasia includes surgical myotomy, pneumatic dilation and injection of botulinum toxin. Success rates range from 32% to 98% and are mostly based on symptomatic improvement. The aim of this study was to evaluate prospectively the symptomatic response and health related quality of life (HRQOL) in patients treated for achalasia. Methods: Eighteen patients with achalasia who presented for treatment were enrolled in the study. Patients completed the Health Status Questionnaire 2.0 (HSQ), a standardized measure of health status, and a symptom questionnaire (SQ) prior to treatment and after an average of 5.2 months follow-up. The SQ (visual analogue scale) measured the severity of dysphagia, regurgitation, chest pain and pressure, cough and heartburn. Symptom scores pre- and post-treatment were compared for all patients. HSQ was analyzed using the Microtest Q Assessment SystemTM. Eight scales describing the components of health status were compared for all patients pre- and post-treatment. Subgroup analyses were done comparing endoscopic versus surgical treatment. Results: To date, 18 patients have completed the follow-up questionnaire. One patient did not complete the HSQ and was excluded from the HSQ analysis. Six patients underwent myotomy, 9 patients had botulinum toxin injection and 3 patients had pneumatic dilation. The average patient age was 56.3 ±17.5 years (range 29-92 years). Ten patients were female (56%). Improvement was noted in patients post-treatment for the following symptoms: dysphagia (mean scores 5.6 pre- and 1.9 post-treatment; p<0.002, t test) and chest pain (mean scores 3.5 pre- and 2.3 post-treatment; p<0.05, t test). Improvement in HRQOL for the social functioning scale was present post-treatment (mean scores 65.4 pre- and 86.8 post-treatment; p<0.01, t test). No significant differences were found in the subgroup analyses for either symptom scores or HRQOL (p<0.05). Discussion: Patients who received endoscopic and surgical treatment for achalasia had significant improvement in dysphagia and chest pain. Improvement in HRQOL on the scale of social functioning was also present. This may be explained by the fact that after treatment patients are able to participate in meals without significant dysphagia or chest pain. Conclusion: This preliminary data shows that treatment for achalasia results in improvement in dysphagia, chest pain and social functioning. Long term study is needed to determine if these improvements are transient or remain present over time.