An uncontrolled comparison of treatments for achalasia

A series of 78 patients with achalasia, seen during a 10-year period, was like those reported by others with regard to age at onset, nature of symptoms, and duration of symptoms. Analysis of the results of 5 different treatment modalities administered allows an uncontrolled comparison heretofore not available from an institution at which no one treatment was favored over all others. Those who were not treated or who received only anticholinergic medication did not become asymptomatic. Those treated by single or repeated bougienage were not improved for more than a few weeks and suffered a 6% incidence of esophageal perforation. Forty-six per cent of those treated by a single pneumatic dilatation were asymptomatic for 1 year or more. Although esophagocardiomyotomy provided symptomatic relief for 1 year or more in 85%, there was a 25% incidence of gastroesophageal reflux.