Esophageal achalasia. Diagnostic and therapeutic implications

Over an 11-year period, 15 patients underwent surgery for achalasia (Heller's operation with added antireflux procedure). Thereafter due to the use of manometry 25 other achalasic patients were diagnosed and 17 of them underwent the same surgical procedure. Manometry was done by means of a triple-lumen catheter as described by Arndorfer. Surgical results in the first group were good in 80% and moderate in 20% with no recurrence or organic complications due to acid reflux, while in the second group good results were 95%. In 16 cases of the second group, diagnosis was based on manometric recordings, since the radiological findings were lacking. Early diagnosis enabled to operate on selected patients according to the motor findings of the esophageal body. Follow-up by manometry revealed in some cases an increase in post-deglutitory motor activity and in two cases a return of a coordinated peristalsis. Clinical and functional results are discussed and the role of manometric studies is stressed in order to improve the knowledge of the pathophysiology of functional diseases of the esophagus.