Esophageal function in achalasia: Preoperative and postoperative manometric studies

Background/Purpose: Aperistalsis observed in children with achalasia may be secondary to sphincteric spasm or reflect a primary esophageal dysfunction. The aim of this study was to assess manometrically sphincteric function and esophageal motility before and after successful myotomy. Methods: Conventional stationary and pull-through manometry were performed preoperatively in 14 patients and postoperatively in 13. Ambulatory 24-hour manometry was carried out in four and eight patients in these two groups, respectively, and the results were compared with those of 23 refluxing youngsters. Results: Sphincter hypertony with lack or incompleteness of relaxation was found preoperatively in all patients, and sphincter pressure decreased dramatically after myotomy in all of them. All patients had aperistalsis preoperatively, and only a few had some primary, but weak, contractions postoperatively. Ambulatory manometry results confirmed a reduced number of motor events even during meals and only insignificant improvement of progressiveness, completeness and amplitude of waves after myotomy irrespective of the time elapsed since the procedure, the degree of recovery of esophageal caliber, and the clinical outcome. Conclusions: Motor disorders in achalasia in children are similar to those of adults with the same disease. Motor recovery is observed only in some patients, although it is never complete, and their esophagi will remain ineffective for life. Because myotomy destroys the sphincter, and motility is permanently impaired in this condition, a fundoplication must be interposed to allow long-term mucosal protection. Copyright (C) 1998 by W.B. Saunders Company.