Retrospective study on symptoms and treatment modalities used and short‐term follow up of achalasia cardia in Indian setting

Abstract

Background: Achalasia cardia is a rare esophageal motor disorder that is frequently diagnosed late. Aim: The aim of this study was to study the symptoms, treatment given, and response to treatment in patients with achalasia cardia in an Indian setting. Materials and methods: This retrospective study included all patients diagnosed with achalasia cardia on high-resolution esophageal manometry, using Chicago Classification v 3.0. On follow up, patients were contacted by telephone, and details of the treatment given and response were recorded in a predesigned pro forma. We excluded overseas patients, postoperative cases of achalasia, and those in whom the manometry catheter could not be passed across the gastroesophageal junction. Results: A total of 452 patients (260 males, median age 44.5 years) were included in the study cohort. The major symptoms included dysphagia for solids and liquids (428, 94.7%), regurgitation (360, 79.6%), naso-oral regurgitation (182, 40.3%), weight loss (322, 71.3%), and chest pain (158, 35%). Type 2 achalasia (229, 50.6%) was the most common subtype, followed by type 3 (154, 34.1%). Chest pain was more common in type 3, and weight loss and naso-oral regurgitation were more common in type 2 achalasia. A majority of patients underwent Heller's myotomy and pneumatic dilatation. Of 280 patients for whom treatment details were available, 98% reported good response to endoscopic/surgical management. Conclusion: The predominant symptoms of achalasia cardia vary per the manometric subtype. Heller's myotomy and pneumatic dilatation are the most commonly used treatment options. Response to treatment is good. The choice of treatment modality was likely influenced by financial reasons and availability of local expertise.

Clinical characteristics and manometric findings of esophageal achalasia—a systematic review regarding differences among three subtypes

“…Dysphasia and regurgitation are common in all subtypes; however, limited studies have reported that regurgitation is more frequent in type I (19) but more severe in type II (6). Previous studies indicated that type II patients reported weight loss more frequently than other subtypes (7,20,21). A possible association between weight loss and subtype of achalasia can include a higher catabolic state and different dietary adaptations in type II; however, further research, including investigation of the relationship between inflammatory status and weight loss, is required due to the small sample size.…”

“…Differences in several factors among the three subtypes, such as symptoms (6,7), manometric findings (8), and treatment response (9,10) have been reported so far; however, because of the limited number of studies, the differences are still controversial, and some argue that the three subtypes are the same consecutive disorders. Based on manometric and histopathological findings, a hypothetical clinical course in which achalasia progresses from type III to type II and then to type I has been suggested (11).…”

A Comparison of Achalasia Quality of Life Index and Eckardt Scores in Assessing Severity of Achalasia Cardia and Prognosis at 3 Months - A Single-Center Prospective Observational Study

“…The usual age of presentation is 25 -60 years [2] . The duration of symptoms before diagnosis varies from 6 months to 5.9 years [3,4] . Almost all patients have solid food dysphagia and the majority of patients complain of liquid dysphagia.…”