Erect esophageal transit scintigraphy, manometry, and barium swallow in assessment of patients with achalasia before and after balloon dilation

Background: Achalasia is a motility disorder of unknown etiology. Diagnostic techniques include
Barium esophagram, simple and widely available, radionuclide transit/emptying scintigraphy, a
low-cost procedures, easy to perform and widely available, well tolerated and require minimum
cooperation by patients and esophageal manometry that continues to be used widely in clinical
practices, primarily because of its perceived value. Aim of this study was to compare methods of
manometry, barium swallow and scintigraphy before and after pneumatic dilation.
Methods and Materials: 17 patients with achalasia of cardia were evaluated both symptomatically
and objectively (esophageal manometry, timed barium esophagram, and scintigraphic emptying
index) before treating them with pneumatic dilation and after. The degree of patient symptom
improvement post therapy was recorded and correlated with improvement of three methods indices.
The degree of improvement after treatment was determined as the percentage of reduction of
symptoms, divided into two groups (1) <80% improvement; (2) success: ≥80% improvement.
Results: 12 (70.6%) of patients had score improvement of ≥80%. All the diagnostic indices were
significantly different between pre and post therapy. But, there was not significant difference
between two groups of symptom improvement for indices of barium swallow or scintigraphy and
also any association or correlation between patient symptom score and barium height improvement
or emptying index improvement.
Conclusions: We yielded 70.6% short-term good result after PD, similar to other studies. Our
results showed that transit or barium study should not be relied upon in isolation for assessment of
the efficacy of treatment.