[Are there clinical differences between typical and vigorous achalasia and response to pneumatic dilatation?]

The aim of this study was to analyze whether the vigorous character of esophageal contraction conditions differences in the clinical characteristics or in response to pneumatic dilatation treatment in patients with achalasia. To do so, a prospective protocol study was designed in which the clinical, radiological, and manometric characteristics of the patients and the response to pneumatic dilatation were compared on the basis of the presence or absence of severe contraction of the esophageal body. One hundred fifty-seven consecutive patients diagnosed with achalasia were included on presentation of a compatible clinical picture and absence of peristalsis in the esophageal body. Out of these patients, 120 presented a manometric pattern of typical achalasia and 37 had vigorous achalasia. Response to pneumatic dilatation was analyzed in 116 patients, 90 with typical achalasia and 26 with vigorous achalasia. Significant differences were only found between the two groups with respect to the greater response tone of the lower esophageal sphincter observed in the patients with vigorous achalasia. There were no differences in the remaining clinical, radiologic or manometric variables compared. Neither were any differences observed in regard to therapeutic response to pneumatic dilatation in the two groups of patients. It may be concluded that differentiation between typical and vigorous achalasia has no clinical or therapeutic significance.