Outcomes of treatment in achalasia: subjective or objective endpoints?: Vaezi MF, Baker ME, Achkar E, Richter JE, Timed Barium Oesophagram: Better Predictor of Long Term Success After Pneumatic Dilation in Achalasia Than Symptom Assessment. Gut 2002;50:765–70

Abstract

In this cohort study, 34 patients who achieved near-complete symptom relief 1 month after pneumatic dilation were followed prospectively to determine whether the results of a timed barium esophagram (TBE) predict early symptom recurrence. Patients were grouped according to results of their TBE, performed at 1 month post-therapy. The discordant group (n = 10) manifested poor esophageal emptying (defined as less than 50% improvement), despite successful symptom relief (defined as 91–100% improvement), whereas the concordant group (n = 22) exhibited successful improvement in both symptoms and barium column height. Two remaining patients revealed intermediate improvement in esophageal emptying, despite symptom relief, and were excluded from the analysis. After 1 yr, significantly fewer discordant group patients (1/10) than concordant group patients (22/22) remained treatment successes ( p < 0.001). Similarly, discordant patients remained in symptom remission for significantly less time than did concordant patients (18 ± 3.6 months vs 59 ± 4.8 months, p < 0.001). At 6 yr time, all discordant group patients had relapsed, whereas 17/22 concordant group patients remained in remission ( p < 0.001). The TBE was after symptom failure in all discordant group patients and continued to manifest poor emptying. Conversely, in 10/17 investigated concordant group patients with persistent improvement at 6 yr, all repeat TBEs (10/10) continued to reveal rapid emptying.