Predictors of a better outcome of pneumatic dilatation in patients with primary achalasia.

OBJECTIVE

Pneumatic dilatation (PD) has been widely used in the treatment of primary achalasia. The aim of this study was to evaluate the effectiveness of PD and its predictive factors in Japanese patients with primary achalasia.

METHODS

Fifty-five consecutive patients were treated using PD (Rigiflex balloon dilator). Diagnosis was established through radiographic and/or esophageal manometry. All patients underwent a pre-designed clinical evaluation prior to and 6 months after PD treatment. We defined success of PD as 6 months or more of clinical remission, with a total score (0-4) <or=2, a decrease in the total score >or=1 and the score for each item <or=1. Possible predictive factors to response were analyzed.

RESULTS

Successful PD was achieved in 41 of 55 (74.5%) patients. The median age (58.0 years) in the successful group was significantly older than in the failure group (37.5 years), but there were no differences in other factors between the groups. When the cut-off value was set at 40 years of age, the success rate of PD in the >40-year age group was 85.7%, while the <40-year age group achieved a rate of only 38.5%. Multivariate logistic regression analysis also demonstrated that older age was the only independent factor associated with the success of PD. There was no perforation related to PD.

CONCLUSIONS

PD is a safe and effective treatment for achalasia, particularly in older patients who experience a better outcome than younger patients.