Empiric Esophageal Dilatation for Nonobstructive Dysphagia

Abstract

Purpose: Dysphagia is one of the most common complaints encountered in gastroenterology. Endoscopy frequently does not reveal any obstruction. Empiric esophageal dilatation is performed in many of these cases for symptomatic relief. The purpose of this prospective study is to determine if there is a significant, sustained response to esophageal dilatation in cases with nonobstructive dysphagia. Methods: Patients presenting with dysphagia who had no obstruction demonstrated upon endoscopy and had empiric dilatation of esophagus were included in the study. Dilatation was achieved utilizing 48 F wire guided Savary dilators in most cases. 102 patients with dysphagia were enrolled. Dysphagia scores [1] were recorded before the procedure and at 2 months, 6 months and 18 months after the procedure. An increase in dysphagia score of one or more was considered an improvement. Number of patients using a proton pump inhibitor (PPI) also was recorded. Paired sample t-test was used to determine the significance of response to the dilatation at the 2-month, 6-month and 18 month intervals. Results: Of the 102 patients enrolled, 88 reported improvement at the 2 month follow up. At the 6 month follow up, 78 patients reported an improvement. At 18 month interval, 68 reported an improvement 18 patients reported no improvement and 16 patients were lost to follow up. Results for 3 follow up intervals achieved statistical significance [Table 1]. Analysis of biopsy results was done. 17 patients had inflammatory changes and 12 had reactive changes. No cases with eosinophilic esophagitis were found. When the study commenced 85 of 102 were on PPI and at closing of study 74 of 86 patients were on proton pump inhibitors (PPI). Of the 12 who were not on PPI, all improved with dilatation alone. No complications were reported from the procedure.Table 1: Results of paired sample t testConclusion: The number of patients reporting improvement in dysphagia scores at all three follow up intervals after dilatation reached statistical significance. Based on the sustained response to the procedure and the lack of complications it can be concluded that esophageal dilatation offers significant relief for non obstructive dysphagia.