Surgical Myotomy Recommended for Achalasia

Achalasia managed by surgical myotomy is less likely to require subsequent treatments compared with pneumatic dilatation, according to new findings.

Researchers from the University of Toronto (Canada) evaluated the outcomes of both surgical myotomy and pneumatic dilatation by linking records from several Ontario (Canada) health databases for the period between 1991-2002. The 1,461 subjects that were over the age of 18 were followed on average for five years. Outcome was defined as the need for a subsequent intervention--pneumatic dilatation, myotomy, or esophageal resection.

Among the 1,181 adult patients who underwent pneumatic dilatation, 36.8% required another intervention within the first year of follow-up, and 56.2% required the same during five years of follow-up. Corresponding rates for the 280 patients treated with surgical myotomy were 16.4% and 36.8%. After adjustment for age, gender, comorbidity, and income status, initial treatment with pneumatic dilatation was significantly more likely than surgery to require another intervention. The results were published in the November 8, 2006, issue of the Journal of the American Medical Association (JAMA).

"Persons with achalasia should be aware of the long-term effectiveness of pneumatic dilatation and surgical myotomy in average practice settings,” concluded authors Dr. Steven R. Lopushinsky and Dr. David R. Urbach, of the University of Toronto. They also advised patients and their physicians to consider the risks of the procedures, the ability of doctors to improve symptoms, the risk of gastroesophageal reflex, as well as costs associated with the longer hospital stay after surgery.

Achalasia is the failure of a ring of muscle (such as a sphincter) to relax. Any smooth muscle fibers at any junction of the gastrointestinal tract such as the pylorus, cardia, or other sphincter muscles can be involved, but the term most commonly refers to esophageal achalasia, a disorder of the esophagus that does not allow food to pass to the stomach.



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