Predictors of response to pneumatic dilatation in achalasia cardia.

Background: The role of esophageal laboratory testing in predicting response to balloon dilatation in patients with achalasia cardia has been evaluated in the West; data in Indian patients are scant.

Aim: To study the predictors of response to pneumatic balloon dilatation in Indian patients with achalasia cardia.

Methods: Twenty-five patients with achalasia cardia who had earlier undergone esophageal manometry before balloon dilatation (Group A) were recalled for clinical evaluation. Another consecutive 25 patients with newly diagnosed achalasia (Group B) underwent esophageal manometry and isotope transit studies before and after dilatation.

Results: The overall symptom response to dilatation in the 50 patients at median (range) follow up of 26 (1-60) months was 64%. Pre-dilatation clinical and laboratory parameters did not predict outcome. All patients with 1-week post-dilatation lower esophageal sphincter (LES) basal pressure less than or equal to 10 mmHg and residual pressure less than 6 mmHg were asymptomatic at follow up.

Conclusion: Post-dilatation LES basal pressure less than or equal to 10 mmHg and residual pressure less than 6 mmHg are predictors of symptom response to balloon dilatation in patients with achalasia cardia.