Evaluation of the response to treatment in patients with idiopathic achalasia by the timed barium esophagogram: results from a randomized clinical trial

Abstract

To choose which treatment would be most effective for the individual patient with newly diagnosed achalasia is difficult for the tending physician. A diagnostic tool that would allow prediction of the symptomatic and functional response after treatment for achalasia is therefore needed. The timed barium esophagogram (TBE) is a method that allows objective assessment of esophageal emptying, but the value of TBE in the clinical management of achalasia remains to be clarified. The aim of this study was first, to assess the ability of TBE to predict symptoms and treatment failure during post-treatment follow-up. Second, to determine whether esophageal emptying as assessed by TBE differs after treatment with pneumatic dilatation or laparoscopic myotomy. Fifty-one patients with newly diagnosed achalasia were prospectively randomized to pneumatic dilatation (n = 26) or laparoscopic myotomy (n = 25). Evaluation with TBE was performed before (n = 46) and after treatment (n = 43). The median interval between treatment and post-treatment TBE was 6 months, and the median follow-up time after the post-treatment TBE was 18 months. Following therapeutic intervention, TBE parameters did not differ significantly between treatment groups. However, significant correlations were found between the height of the barium column at 1 min and the symptom scores at the end of follow up for 'dysphagia for liquids' (P < 0.05, rho = 0.47), 'chest pain' (P < 0.05, rho = 0.42), and the 'Watson dysphagia score' (P < 0.05, rho = 0.46). Patients with less than 50% improvement in this TBE-parameter (height at 1 min) post-treatment had a 40% risk of treatment failure during follow-up. In summary, pneumatic balloon dilatation and laparoscopic myotomy similarly affected esophageal function as assessed by TBE-emptying. Lack of improvement in barium-column height post-treatment was associated with an increased risk of treatment failure which should motivate close surveillance in order to detect symptomatic recurrence at an early stage.

Effect of laparoscopic esophagomyotomy on chest pain associated with achalasia and prediction of therapeutic outcomes

“…Timed barium esophagography has been widely recognized as a simple and objective index of esophageal emptying among patients with achalasia [16,17]. The results from the current study therefore suggest an association between improvement in esophageal emptying and a therapeutic effect on chest pain.…”

Achalasia: A review of Western and Iranian experiences

“…In a randomized clinical trial of 51 patients who underwent surgery or pneumatic dilation, results of the timed barium esophagogram also correlated well with outcome. Poor improvement in barium height following the treatments was associated with an increased risk of treatment failure [29] .…”

Peroral Endoscopic Myotomy for Treating Achalasia and Esophageal Motility Disorders

“…[24][25][26][27] For objective measurements of efficacy, various parameters can be compared before and after the treatment of achalasia. The objective parameters include barium column height in timed barium esophagograms (TBE), 28,29 LES pressure, integrated relaxation pressure, 30 and GE junction distensibility as measured by EndoFLIP (Endolumenal Functional Lumen Imaging Probe; Crospon, Galway, Ireland). 31 Many studies regarding POEM reported not only subjective clinical symptomatic success, but also objective assessment.…”