Diagnosis of achalasia, A Sri Lankan study

Abstract

BACKGROUND :A definitive diagnosis of achalasia is usually provided by oesophageal manometry. Though stationary oesophageal manometry is available in Sri Lanka as a diagnostic tool since 1998, the diagnosis of achalasia continues to be based on barium swallow studies. METHOD: Clinic records of all patients who had features of achalasia on stationary oesophageal manometry (from 1998-2006) were reviewed and analyzed. RESULTS: A total of thirty six (36) patients with achalasia were identified. There were 34 adults [median age 40 (range 24-72 years)] and two paediatric patients (5 yrs & 10 yrs.). Dysphagia for solids (with or without regurgitation) was the main presenting symptom in 28(78%) patients. Six patients (17%) had retrosternal chest pain or heartburn as the main presenting symptom and were treated as having GERD. Vomiting after meals was the main presenting complaint in the two pediatric patients. Upper GI endoscopy showed oesophageal dilatation (± retained food particles) in 13(41%) subjects while in the rest (59%) the findings were inconclusive. Achalasia was stated as a diagnostic possibility in radiologists' reports in only 17(47%) patients (sensitivity of the test 47%). The duration between the onset of symptoms and the manometric confirmation of the diagnosis was 3 years (range 0.25 - 7). CONCLUSION: Though barium swallow continues to be used to diagnose achalasia, neither this nor upper GI endoscopy has high sensitivity and leads to a significant delay in the diagnosis. In patients with symptoms of upper GI obstruction, a normal endoscopy should be followed by early oesophageal manometry