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Reflux in untreated achalasia patients
J P Shoenut1, A B Micflikier, C S Yaffe
1Department of Medicine, St. Boniface General Hospital, Winnipeg, Manitoba, Canada.
Journal of Clinical Gastroenterology
|January 1, 1995
Summary
Achalasia patients often have normal acid reflux, but some show abnormal levels. Treatments to reduce esophageal pressure may increase acid exposure, necessitating pre- and post-treatment pH monitoring.
Area of Science:
- Gastroenterology
- Esophageal Physiology
- Acid Reflux Studies
Background:
- Achalasia is a primary esophageal motility disorder.
- Abnormal acid exposure in achalasia patients is not well understood.
- Standard diagnostic methods may not fully capture acid reflux in achalasia.
Purpose of the Study:
- To prospectively assess distal esophageal acid exposure in untreated achalasia patients.
- To evaluate the impact of achalasia treatments on acid exposure.
- To determine the correlation between acid reflux and lower esophageal sphincter pressure.
Main Methods:
- Prospective assessment of 48 untreated achalasia patients.
- Utilized 24-hour ambulatory esophageal pH monitoring.
- Conducted in vitro lactobacillus fermentation studies.
- Performed repeat pH studies post-treatment (pneumatic dilatation or myotomy).
Main Results:
- Most patients (38/48) had normal acid reflux levels.
- Approximately 20% (10/48) exhibited abnormal acid exposure.
- No significant difference in reflux between normal and abnormal groups based on LES pressure or retained food.
- Some patients showed increased acid exposure after pneumatic dilatation or myotomy.
Conclusions:
- Patients with achalasia require both pre- and post-treatment esophageal pH studies.
- Treatments aimed at decreasing resting esophageal sphincter pressure can increase distal acid exposure.
- Asymptomatic patients may present with significant pretreatment acid reflux.