Patient Reported Outcomes After Pneumatic Dilation for Achalasia

Abstract

Introduction: Patient reported outcomes (PRO) and quality of life (QOL) in achalasia patients are an emerging determinants of achalasia treatment success. We examined PRO after pneumatic dilation (PD) in treatment naive patients to assess correlation with the Eckardt score, an objective measurement of disease severity. We also explored PPI use and GERD symptoms before and after PD as a measure of QOL. Methods: An IRB approved retrospective cross-sectional study was conducted at a tertiary care university clinic. 51 treatment naive patients seen between 2002-2014 with manometric diagnosis of idiopathic achalasia were included. Patients with confounding esophageal or autoimmune pathology were excluded. Patients responded to a telephone questionnaire based on the Achalasia Severity Questionnaire regarding pre- and post-PD metrics including QOL, perception of disease severity, GERD symptoms, PPI use, and willingness to undergo repeat PD. Descriptive statistics, Wilcoxon sign rank test for matched pairs, and Spearman correlation were used for statistical analysis. Results: Eckardt score, QOL, and perception of disease severity improved after PD (p<0.001). Associations between improvements in Eckardt score and QOL (r2= -0.429, p<0.01); Eckardt score and perception of disease severity (r2=0.389, p<0.01); and perception of disease severity and QOL (r2=0.561, p<0.01) were found. There was a weak correlation between improved QOL and decreased PPI use (r2= -0.141, p<0.05). There was no significant association between PD failure and worsening of QOL, perception of disease severity, or Eckardt score (p=0.41). 22/51 patients reported pre-PD reflux symptoms compared to 14/51 post-PD. 31/51 reported pre-PD PPI use compared to 19/51 post-PD. Reported reflux symptoms decreased after PD (X2, p=0.017). Conclusion: PD improves Eckardt scores, QOL, and perception of disease severity in treatment naive achalasia patients. Improvements in QOL and perception of disease severity are associated with improved Eckardt scores, and are therefore reasonable metrics for gauging PD success. PD failure did not result in worsening of QOL, perception of disease severity, or Eckardt scores. Though post-procedural GERD is commonly reported, we found that reported reflux symptoms and PPI use decreased after PD. We conclude that patient reported outcomes are important factors in a holistic treatment approach to achalasia.