24-h pH monitoring patterns and clinical response after achalasia treatment with pneumatic dilation or laparoscopic Heller myotomy

Aliment Pharmacol Ther. 2010 Nov;32(10):1257-65. doi: 10.1111/j.1365-2036.2010.04461.x. Epub 2010 Sep 25.


Background: The most effective treatment for achalasia is pneumatic dilation or myotomy. The best option is still controversial and incidence of complications could help choosing. Gastro-oesophageal reflux (GER) is the most frequent complication after treatment for achalasia. The 24-h pH monitoring (24-h pH) is the best method to evaluate true GER.

Aim: To analyse the 24-h pH patterns after treatment, correlating with therapeutic success.

Methods: Untreated patients with achalasia were randomized to pneumatic dilation or laparoscopic Heller myotomy with fundoplication (LHM+Fp) and evaluated with clinical/manometric results and 24-h pH.

Results: Ninety-four patients were analysed pre-treatment and 85 post-treatment. Clinical success was 73.8% in pneumatic dilation group and 88.3% in LHM+Fp group (P = 0.08). The incidence of GER was 31% in pneumatic dilation, and 4.7% in LHM+Fp (P = 0.001). The occurrence of hypotensive lower oesophageal sphincter (LES) was 53.3% in patients who developed GER and 28.6% in patients with 24-h pH suggesting fermentation (P = 0.019). The rates of dysphagia resolution in patients with 24-h pH of GER and fermentation were respectively 86.7% and 85.7% (P = 0.89).

Conclusions: True GER 24-h pH is more frequent after pneumatic dilation for achalasia, and it is associated with a hypotensive LES. A 24-h pH suggestive of fermentation or true GER is not associated with worse clinical/manometric results.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Aged
  • Dilatation / adverse effects*
  • Esophageal Achalasia / surgery*
  • Female
  • Gastric Acidity Determination
  • Gastroesophageal Reflux / etiology*
  • Humans
  • Laparoscopy / adverse effects*
  • Male
  • Middle Aged
  • Postoperative Complications
  • Statistics as Topic
  • Time Factors
  • Treatment Outcome