| PrefaceAchalasia of cardia (AC) which is named cardio spasm again is kind of disease which is the disorder of motivation of esophagus. The main clinical appearances are dysphagia, reversing food, retrosternal pain, loosing weight, aspirated pneumonia and so on, to impact the quality of life of patients seriously.The diagnosis are main on the basis of clinical appearances, esophageal barium radiography, endoscopy and esophageal manometry and so on . X - ray and endoscopy are not great value for the diagnosis for earlier period of AC ,but esophageal manometry is better for the diagnosis of AC , to reflect some mark appearances of dyskinesia of esophagus , to help to diagnose LES, UES, esophageal body and pharyngeal motor function , as well as to make the diagnosis and classification , meanwhile , to evaluate the curative effect of the treatment of operation and non - operation for esophageal motility disease. Esophageal manometry has the main appearances, as the disorder of relaxation of LES while swallowing, the increasing of LESP while resting, the deficiency of forward peristaltic wave of esophageal body ,the higher pressure which intraesophageal pressure is than intragastric pressure .AC is a kind of disease, which is the disorder of neuromuscular movement of esophagus and cardia. . The key to treatment is to make cardia relax. At present, the method of treatment for AC is only to decrease pressure gradient of LES, thus to relieve symptom . The treatments of AC include dilatation, botuli-num toxin injection, Heller operation, mictomyotomy, drug treatment, alligation stent, traditional Chinese medicine and so on. Recently, dilatation has been accepted for the treatment of AC widely. Dilatation has been done under X - rayand endoscopy, which has three methods, such as hyponome, aerocyst and metal - stent. Balloon dilatation makes use of mechanic dilatation to oppose the contraction of LES, over -tension by force, to make part of leiomy chalasia or loose tension, to achieve curative destination. Dilatation procedure under endoscopy is safe and convenient, short of time of therapy, few - complication, which is suitable to patients of cardiorespiratory function seriously damaged and late pregnancy.At present, we have made great progress for the treatment of AC, but any methods are hard to correct the defects of pathophysiology . All treatments are to aim at relieving symptoms, while the normal motor function of esophagus can not be restored . If we want to exceed the traditional treatment, we should rely on the more research of pathogenesis and pathophysiology. So we should carry out appraisal and research of large sample for clinical diagnosis and treatment of AC , as well , it will offer important clues for the pathophysiology of AC to guide the right clinical diagnosis and treatment in the future .This research analyzes a group of patients who are suffered by AC, we compare the differences between the pre - dilation and post - dilation on the clinical appearances, typical esophageal barium radiography, endoscopy and esophageal motor function before and after dilatation , to evaluate the significance of esophageal manometry . At the same time , we give the objective evaluation for the treatment of balloon dilatation for AC and study its clinical value , to guide the clinical treatment for AC preferably.MethodThirty seven patients were diagnosed as having achalasia by clinical features , barium radiography, endoscopy and esophageal manometry.1. Evaluating method of symptom score of dysphagia, reversing food and retrosternal pain is: no symptom - 0;mild - 1;medium - 2;serious - 3.2. The method of barium radiography;Barium radiography would be done at once when patients had been having 200 percent baso4 500ml if they have been treated for three days and stopped having meal for 12 hours. Then the max-imal width of the esophagus would be measured.3. The method of esophageal manometry: Domestic ways in common use was liquid pouring on low compliance at present. Pulling out to purposeful point would be done. Such datum would be measured;LESP, LESL, LESRP, LES-RR, pressure of esophageal body, UESP and UESL, Contraction amplitude and time of peristalsis.4. Method of balloon dilatation: The balloon was inserted into stricture of cardia following guidewire under endoscopy . The balloon has been pouring into gas until its pressure has up to 13.68 Kpa. Such pressure had continued for one minute, then interrupted for one minute. Dilatation was done twice. Appropriate amount of anti acid medicines and protective medicines of mucosa would be used after dilatation.Result1. Clinical symptom: The clinical symptom of dysphagia, reversing food and retrosternal pain was distinctly ameliorated after dilatation, even spreaded 2—12 months, and averaged 8. 0 months . The maximal esophagus width were significantly decreased after treatment (P <0. 01) , The effective rate of therapy was 97. 3% (36/67).2. Kinetic changes in esophagus before and after treatment;LESP and LESRP was significantly lower after therapy ( P <0.01) , LESRP was not apparently increased . All datum of UES showed no difference as compared to the datum before therapy (P>0.05). No forward peristaltic waves appeared in all patients.3. Complications: 94. 6 percent (35/37) patients were rended in cardia mucosa and occurred a little hemorrhage. They neednt particular therapy. 51.4 percent (19/37) patients suffered short - term mild retrosternal pain, 32.4 percent (12/37) patients suffered reversing acid and 27.0 percent (10/37) heartburn . No serious hemorrhage and esophageal perforation occurred during following up.ConclusionEndoscopic balloon dilation could relieve the clinical symptom apparently and improve esophageal motility in achalasia. It is a simple and safe method with remarkable effectiveness and has the advantages of gently pain and few complication . So it is worth popularizing.
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