[The clinical significance of the magnitude of esophageal dilatation in idiopathic achalasia].

The relationship between the diameter of the esophageal body and the clinical profile of the disease and response to treatment was analyzed in 151 patients with idiopathic achalasia by pneumatic dilation of the cardias. Of the 151 patients, 46 presented an esophageal diameter < or = 3 cm (group I), 78 a diameter > 3 cm up to a maximum of 5 cm (group II) and 27 presented a diameter > 5 cm (group III). The result of pneumatic dilatation of the cardias under endoscopic control was analyzed in 117 patients with a minimum follow up of one year after the last dilatation session. Of all the clinical parameters studied, significant statistical differences were only found in group III in respect to the time of symptom evolution and the presence of regurgitation. Manometric data in basal pressure of the esophageal body and in contraction wave width were lower in groups I and III, respectively. The remaining variables were similar in the three groups although group III showed a trend to older age and the frequency of pulmonary complications with lesser thoracic pain and registry of a strict pattern. Endoscopic pneumatic dilation carried out in all the cases was effective in 83% of the patients and was similar in the three study groups. The rate of complications (perforation) was also similar. The therapeutic efficacy of pneumatic dilatation was accompanied by a significant reduction in esophageal diameter. It was concluded that the increase in esophageal diameter in idiopathic achalasia is associated with chronological, clinical and functional parameters which suggest greater disease evolution but do not determine significant changes in the therapeutic response to endoscopic pneumatic dilatation.