Long-term results of esophageal motor dysmotility after Heller's myotomy for achalasia

Abstract

To investigate the long-term characteristics of both clinical manifestation and esophageal motor disturbance in achalasia patients after Heller's myotomy. After 3 to 10 years' follow-up, clinical manifestation, esophageal motor function and 24-hour continuous esophageal pH monitoring in 72 post-operative cases of achalasia were recorded. The mean LES pressure decreased from 44 + or - 12 mm Hg to 10 + or - 5 mm Hg, and the rate of L ES relaxation rised from 49% + or - 20% to 84% + or - 15% (paired t test, P < 0.05). Of 24 cases with choking feeling, 11 had the high LES pressure and dysfunction in two directions and 7 in three. During swallowing, incomplete lower esophageal sphincter relaxation and aperistalsis were detected in all patients. The long-term characteristics of esophageal function following successfully surgical treatment to patients with Achalasia are: (1) After Heller's myotomy, LESP in at least one direction is lower than the normal standard, while higher in at least one direction. (2) During swallowing, the esophageal rear wall is lack of complete LES relaxation. For patients with choking feeling, complete LES relaxation occurs in 2-3 directions. (3) Due to lack of esophageal peristalsis, food goes through esophagus by gravitation.