ACTA FAC MED NAISS 2011;28(4):209-218

Original article

UDC:616.329-009.1-07

Clinical Quality of Life and Manometric Findings in Newly Diagnosed Achalasia Patients

Srđan Kostić¹, Magnus Ruth², Ann Kjellin³, Lars Lundell³, Erik Svartholm⁴, Mats Andersson⁵, Hans Lönroth⁶

¹Department of General Surgery, Borås Central Hospital, Borås,

²Department of Otorhinolaryngology, Sahlgrenska University Hospital, Gothenburg,

³Department of Surgery, Karolinska University Hospital, Huddinge, Stockholm,

⁴Department of General Surgery, Jönköping Central Hospital, Jönköping,

⁵Department of Radiology, Sahlgrenska University Hospital, Gothenburg,

⁶Department of General Surgery Sahlgrenska University Hospital, Gothenburg, Sweden


summary

Scanty information is available regarding the clinical characteristics, quality of life (QoL) profile and manometric findings in unselected newly diagnosed cases of achalasia. Fifty-six consecutive cases of newly diagnosed achalasia have been characterized regarding the symptoms when a standardized protocol was applied, to which was added a more detailed instrument enabling a comprehensive description of the character of the swallowing difficulties. The functions of the esophageal muscle wall and distal sphincter (LES) were recorded by use of standard manometry technologies and a specialized sleeve catheter. These patients’ health related quality of life (QoL) has been characterized by use of the instruments-Psychological well-being index Gastrointestinal symptom Symptom rating scale Scale. Most patients presented with a long duration of symptoms (54,5 months). The doctor’s delay amounted to 5,5 months despite profound swallowing difficulties (Watson score 30.5+/- 1.7; m+/- SE). QoL was significantly impaired both when generic (PGWB) and disease specific (GSRS) instruments were applied. This deterioration was most likely caused by the eating disturbances. At the time of diagnosis the motor characteristics of the esophageal body as well as the LES were severely affected. The vast majority of patients with achalasia are diagnosed at a stage when the disease process has already profoundly destroyed the motor function of the esophagus and the gastroesophageal junction and the quality of life are severely impaired.

Key words: achalsia, symptoms, dysphagia, manometry, lower oesophageal sphincter, quality of life, 24-hour pH monitoring