Choice of therapy for achalasia in relation to age

Over an 11-year period 132 patients with achalasia underwent a total of 253 pneumatic bag dilatations of the cardia as the initial treatment. Adequate symptomatic relief was obtained in the majority, but 16 needed cardiomyotomy after pneumatic dilatation had failed to give lasting symptomatic relief. Older patients, aged 60 years or more, showed longer-lasting improvement with pneumatic dilatation than did younger ones and only 1 patient over 50 required cardiomyotomy. Benefit from pneumatic dilatation showed a closer relationship to age than to oesophageal diameter. Of 50 patients followed for more than 5 years, 48% required no further treatment, 40% needed at least one further dilatation to achieve symptomatic relief and 12% came to cardiomyotomy. This study suggests that pneumatic dilatation is safe, effective and particularly useful in the management of the elderly achalasic patient.