The Clinical Study Of Pneumatic Dilations Rherapy For Achalasia

ObjectivesEvaluate the improvement of the patients undergoing pneumatic dilation by comparing pre and post dilation standardized symptoms score with barium height and barium width. And test the correlations between symptom scores and the height and the width of the barium column at 1 minute and 5 min after barium ingestion.Analyze the impact of the gender and the age to the improvement of the treatment.MethodA total of 63 patients (29 men; mean age, 44±15.1 years(11-73)) with achalasia who were treated with pneumatic dilation between 2005 and 2009 were analyzed,which underwent 90 pneumatic dilations.All of the pneumatic dilations were performed with the 3.2-cm balloon. Pre and post dilation symptom scores were recorded. Barium column height and width was measured 1min and 5min after ingesting a fixed volume of barium to assess oesophageal emptying. Test the datas to make sure the improvement of the treatment. Improvements in patient symptoms, as well as esophageal barium emptying, were each classified into three groups: 1)little respnders:50% improvement; 2) partial responders: 51–90% improvement; or 3) perfect responders: 91–100% improvement. Analyze the association between the degree of patient symptom improvement and esophageal emptying measured by barium column,but also the impact of gender and age to the improvement.RusltThere was significant difference (p﹤0.005) between pre-dilation patients′symptoms scores(dysphagia, chest pain,?regurgitation and total scores), and 5 min barium height and post-dilation patients′,but this difference could not be observed in the 5 min barium width between pre-dilation patients and post-dilation patients(p=0.063). Significant correlations were found between the height of the barium column at 1 minute and the symptom scores for dysphagia (P< 0.05,rho= 0.47),chest pain (P< 0.05,rho= 0.42) and the tatol scores (P< 0.05,rho= 0.46) after dilation.However,there were no significant correlations(p﹥0.005) between the symptom scores and the height of the barium column at 1 minute,the height and the width of the barium column at 5 minute. In 73 of 90 (81%) pneumatic dilations, the degree of symptom and barium height improvement was similar.30 dilations with 0-50% improvement in both symptoms and barium height.Compared with the 29 patients with 91–100% improvement in both symptoms and barium height. There was a significant association between patient symptoms and barium height improvements in the two groups.The study also suggested that the difference of age was the reason for the difference of the treatment improvement.ConclusionsAlthough pneumatic dilation is an effective primary treatment in patients with primary achalasia, patients are at risk of recurrent disease, with this risk increasing during long-term follow-up.In this study, the improvement of the pneumatic dilation treatment for 63 patients is 70% after a 5-years folling-up. There was a significant association between patient symptoms and barium height improvements, both of which can use to evaluate the improvement of the treatment. Age is a reason for the difference of the treatmenegt improvement; gerenral speaking the older patients can achive better improvement than the youger patients.