Effectiveness of esophageal dilation in relieving nonobstructive esophageal dysphagia and improving quality of life.

Abstract

The role of empiric esophageal dilation in improving esophageal dysphagia with nonobstructive esophageal lumen is not clear. We wished to determine the impact of esophageal dilation with a large-diameter dilator on dysphagia and quality of life in such patients. We also assessed relative prevalence of esophageal versus oropharyngeal dysphagia and nonobstructive versus obstructive esophageal dysphagia in ambulatory patients. Ambulatory patients presenting with swallowing complaints were evaluated by history and physical examination, speech therapy evaluation, dynamic barium oropharyngeal swallowing study, and barium esophagram plus upper endoscopy. Patients diagnosed as having nonobstructive esophageal dysphagia were offered participation in the study. Eligible candidates were randomized to either 56-French (the study group) or 40-French (the control group) Pilling dilators. All patients were treated with proton pump inhibitors. Patients completed questionnaires for dysphagia score, diet score, and quality of life (SF-36) at baseline, at 1 month, and then at follow-up visits at 1- to 3-month intervals for up to 12 months. Of the 125 patients complaining of swallowing difficulties, 6 (5%) were diagnosed as having oropharyngeal dysphagia and 119 (95%) had esophageal dysphagia. Of the patients with esophageal dysphagia, 84 (67%) had nonobstructive dysphagia. A total of 30 patients participated in the study. Seventeen patients were randomized to the study group and 13 were randomized to the control group. The baseline dysphagia, diet, and quality-of-life scores were comparable between groups. Dysphagia in both groups improved after dilation compared with baseline; however, the difference in the degree of improvement between the two groups was not significant. In addition, there was no significant difference in improvement of the quality of life between the two groups. Most patients with esophageal dysphagia have a nonobstructing esophageal lumen. Our prospective, randomized, controlled study does not support the practice of empiric esophageal dilation for patients with nonobstructive esophageal dysphagia. Improvement in both groups suggests the possibility that it occurred due to proton pump inhibitor therapy, lending credence to the hypothesis that esophageal hypersensitivity to acid contributes to symptoms in most patients with nonobstructive esophageal dysphagia, which is the predominant category of dysphagia.