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BackgroundPneumatic dilation (PD) is often billed as a “short term” treatment for achalasia but anecdotally can last years. This study sought to explore how long a single pneumatic dilation may induce symptom remission in a treatment-naïve achalasia patient.MethodsA single center, retrospective chart review of patients with an ICD-9 or − 10 code of achalasia between 2005 and 2017 was performed. Treatment naïve patients with manometric diagnosis of primary achalasia were included. Outcomes (success or failure); single vs multiple PD; age; and estimated duration of effect were evaluated. Each patient underwent a single PD unless re-intervention was required for relapse.Results83 patients (52% female, median 51.6 ± 3.6 years) were included. 43% underwent 2 PD and 13% underwent 3 PD. There was no significant relation between age, gender, and number of PDs. After 1 PD, 87.5% of patients reported > 1 year of symptom remission. 80.5% of relapsed patients reported success after a 2nd dilation. 1 PD was more likely to result in success than multiple PDs (p < 0.001). The measured median duration of remission after 1 PD was 4.23 years, and for 2 PDs, 3.71 years. The median estimated remission time after 1 PD was 8.5 years (CI 7.3–9.7, p = 0.03).ConclusionsPD is a safe, durable treatment for achalasia. A single PD is likely to last years. A second PD, if required, also has a high likelihood of success.

The present research describes a method of combining geostatistical analysis with geophysical inversion of electrical resistivity data conducted in Pakhli Plain, northwestern Himalayas, Pakistan. The raw data has been collected from the Technical Report VII-I on Ground Water Resources in Pakhli Plain, Mansehra District. Subsequently, the data has been deciphered and broadened from one dimensional resistivity data into a 2D model that can be entirely visualized and deduced in a spatial sense. Interpretation and calibration of the electrical resistivity curves with the lithologies and geophysical logs of boreholes suggests possible identification of distinctive sedimentary accumulations occurring within the Pakhli Plain. The 2D and 3D gridding and visualization is imperative to map the extents of the alluvial deposits within the Pakhli Plain formed during the periods of extreme tectonic activity. The coarser sediments are associated with lower levels of resistivity as measured in the electrical surveys, whereas the finer sediments exhibit characteristically lower resistivities. Therefore, the zones of low and high resistivity values are indicative of particles associated with coarser and finer sediments, respectively. It has been mentioned that the Pakhli Plain has remained a lacustrine zone during some time in the geological past as indicated by low resistivities representing finer sediments in the middle of the Plain. Consequently, the overall transmissivity of the sediments is low, which imply poor conditions for commercial groundwater production in the Pakhli Plain. Moreover, high resistivity zones of coarse material could be further investigated for groundwater potential areas. In particular, the prime objectives of the present study include 3D modeling of underground resistivity and its exploration in terms of groundwater potential on the basis of distribution of low resistivity zones.

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INTRODUCTION: The Lyon consensus defined diagnostic guidelines and criteria for GERD and NERD. pH impedance testing is a mainstay of diagnostic confirmation of GERD, but use of PPI prior to pH impedance testing can confound results if esophageal acid exposure (EAE) interpretation is not adjusted for this variable. We sought to demonstrate the necessity of selective EAE criteria in those on PPIs to improve diagnostic accuracy of pH impedance testing. METHODS: 117 consecutive adult patients referred for medication (H2RA, PPI) refractory GERD-symptoms were included. Patients completed RSI, GERDQ, and then 24 hour pH impedance. Patients were divided into 2 groups, those on PPI (n = 82) and those off PPI (n = 35). EAE was interpreted first with uniform off therapy criteria; then the PPI group was re-interpreted with selective on therapy cutoffs. On therapy cutoffs for normal acid exposure were < 1.5% upright and < 0.5% recumbent; off therapy cutoffs were < 6.3% upright and < 1.2% recumbent. RESULTS: In group 1 (on PPI), when on-therapy criteria were applied, 37% (31/82) of patients had abnormal EAE, while with the uniform criteria 25.6% (21/82) had abnormal EAE. In group 2 (off PPI), 13/35 (37%) had abnormal pH-impedance results. There was a significant difference between the two groups (P = 0.02). Those on PPI did not have significantly improved abnormal upright EAE (23% vs 11%, P = 0.44), recumbent EAE (16% vs 11%, P = 0.53). Those on PPI therapy had a greater number of abnormal GERDQ (56.1% vs 45.7%, P = 0.30) and RSI (74.4% vs 60.0%, P = 0.12). CONCLUSION: Application of selective criteria for EAE interpretation improves diagnostic accuracy of pH impedance testing, though those with abnormal EAE are not significantly more likely to have positive GERDQ or RSI results. PPI use does not decrease individual abnormal upright or recumbent esophageal acid exposure when selective criteria for PPI use are applied.