Supine and upright radionuclide esophageal transit before and after treatment for achalasia

The authors hypothesized that radionuclide esophageal transit (RET) studies performed in the upright position and aided by gravity would provide better objective evaluation of achalasia than supine scanning and would correlate better with the degree of symptomatic relief after treatment. Radionuclide esophageal transit studies were prospectively performed in both the supine and upright positions in four symptomatic patients before treatment, after simple dilation, and after pneumatic dilation in patients who did not respond to simple dilation. After simple dilation, two patients reported near resolution of symptoms. Supine RET revealed little improvement, but upright esophageal emptying was markedly improved at 2, 5, and 10 minutes. In the two patients who had no relief after simple dilation. RET failed to show improvement while they were in either the supine or the upright position. These patients subsequently underwent pneumatic dilation that resulted in resolution of symptoms and marked improvement in upright RET only. In the supine position, the esophageal emptying at 2 minutes in the four patients after successful dilation improved from 0% baseline to a mean of 14% (+/- 18%). However, in the upright position, esophageal emptying improved from 3% (+/- 3%) to 73% (+/- 17%) and better correlated with symptomatic relief. The difference in improvement in esophageal emptying in the upright versus the supine position was statistically significant (P = 0.0033). The authors conclude that only upright esophageal emptying provides objective evidence that correlates well with symptomatic relief.(ABSTRACT TRUNCATED AT 250 WORDS)