Discussion

Achalasia is a relatively rare disease. The incidence of achalasia varies between

studies, but the majority of incidence rates reported range between 0.5-1.2 per

100,000/year.1 We evaluated symptomatology pre and post-surgically with 3

clinical evaluation scales (GERD, EAT-10 and Eckard score) apart from this we

used various studies to confirm diagnosis (barium swallow contrast study and

endoscopy) and high- resolution manometry to evaluate

In our study we did not find significant differences between the types of achalasia

regarding symptom scores, our study demographics did not have any statistical

bias, since we did not have any type of selection criteria, any patient with high-

resolution manometric pattern, barium swallow contrast study and endoscopy

consistent with achalasia diagnosis, was included in the group; independent of

age, height or weight.

The symptoms referred by the patients before the surgical intervention in all clinical

evaluation scales pre-surgery had a significant decrease in all postsurgical follow-

up assessments.

In respect to the EAT-10 scale to evaluate the difficulty for swallowing and GERD

for pyrosis scale score we observed a significant decrease in the mean score in all

the follow-up assessments after a Heller myotomy. EAT-10 scores dropped from a

mean of 32 to a mean score of 2, as seen in the results and figures, as for GERD
scale score, patients referred asymptomatic or barely symptomatic in the follow-up

consults after the surgery, with pyrosis being present in only 4 out of the 39 that

referred it before the intervention. (Figure 1)

When analyzing Eckardt scores in all patients, for the evaluation of symptoms, we

observed a decrease in the mean score in all the follow-up assessments after

invasive maneuvers for achalasia, (Figure 2) before surgical intervention

regurgitation was found in 66 patients, dysphagia in 70 and retrosternal pain in 60,

all of them referred symptoms from occasional to present in each meal. There was

no evidence of symptoms improvement with the change in the manometric pattern.

In a prospective study conducted in 2017. 6

The posterior analysis of each individual symptom was found to be substantially

considerable and had an important decrease, in all the follow-up assessments

GERD pyrosis was only referred by 4 patients, regurgitation in 12, dysphagia in 28

and retrosternal pain in 21 patients, going from almost present in each meal, to

almost non-existent or rare, showing that the invasive maneuvers implemented for

the treatment of achalasia in this group of patients was substantially positive

regarding symptom improvement and eradication.

In addition, in the symptomatic evaluation we could demonstrate as we expressed

earlier that
Changes in the IRP have been demonstrated in patients after performing invasive

maneuvers for the treatment of achalasia. 3,4,5 has been shown that IRP is the best

parameter to evaluate the function of the esophagogastric junction. 2 We observed

a significant decrease in IRP after a Heller myotomy with a sustained effect in

these patients, and it was evidenced in the first-year follow-up assessment.

Even though manometric response is the same in the pre and postsurgical

assessment according to the Esophageal Motility Disorders classification Chicago

3.0, we could observe that after invasive maneuvers patients do not meet the

criteria for a reclassification of achalasia, due to the type of surgery performed in all

of them.

Waves are still aperistaltic in the vast majority of patients preop and post-surgery,

DL and break show no significant difference in the post-surgery assessment,

regardless of the time, but at the 20-month follow-up consult we observe an almost

complete symptomatic resolution.