Abstract
Aim of the work: Achalasia is a rare pathology whose physiopathogenesis is mysterious. The treatment is based on endoscopic pneumatic dilation (PD) and surgery. The aim of our work is to show our experiment about endoscopic pneumatic dilation as the principal treatment suggested for patients presenting achalasia. Material and method: It is a retrospective study relating 21 cases of achalasia indexed between 2002 and 2007. The remission was judged on Eckardt’s clinical criteria. If the symptoms persist after three episodes of PD, there’s a therapy failure and the patients were then proposed to surgery or recurrent DP. The results: The Middle Age at the time of diagnosis was of 44 ± 10, 66 years (20 to 76). The sex ratio was 1, 3 (12M?9F) (p = 0.5). The diagnosis of achalasia is based on imaging, endoscopy and manometric arguments. The PD of the cardia was proposed in first intention, except two patients who were treated 6 and 15 years before by surgery. 38 dilations were performed for 21 patients with an average of 1.8 PD per patient [1-6]. The rate of good answers after the third episode of PD was about 90.47% (19 patients). There was no complication of the PD. In plain-varied analysis, no predictive factor of good answers to PD was retained. Conclusion: PD is an effective cure with a negligible morbidity and no mortality. The surgery is reserved for the failures of pneumatic dilation.
Highlights
The primary achalasia of the esophagus is a rare disease known since a long time
The aim of our work is to show our experiment about endoscopic pneumatic dilation as the principal treatment suggested for patients presenting achalasia
The pneumatic dilation (PD) of the cardia was proposed in first intention, except two patients who were treated 6 and 15 years before by surgery. 38 dilations were performed for 21 patients with an average of 1.8 PD per patient [1,2,3,4,5,6]
Summary
The primary achalasia of the esophagus is a rare disease known since a long time. In 1647, Thomas Willis [1] reported the first case of a patient treated for 15 years by removing the obstruction of his cardia using a rod with whalebone and a ball sponge fixed to its end. The rarity of the disease did not fully permit to understand the pathogenic mechanisms. The most recent theories suggest autoimmune, infectious and genetic factors. The advent of esophageal manometry has allowed the diagnosis of dysphagia before without organic lesions by endoscopy and radiology. Several treatments have been proposed but none is healing. Pneumatic dilation (PD) and surgical cardiomyotomy are treatments that allow prolonged remission [2]
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