Another interesting paper by E. Richter, MD, FACP

[Guest guest]

The Diagnosis and Misdiagnosis of Achalasia: It Does Not Have to Be so

Difficult

http://www.cghjournal.org/article/S1542-3565%2811%2900622-7/fulltext

There are a number of interesting points in it.

There are points about why tests are needed, what they tell and what

their weaknesses are, and when manometry may not be needed. Also, how to

do some of the testing.

He makes some good points about why you want to find a good manometry

center, with high resolution sensors, and not just let the local center

do it with their outdated equipment. The HR manometry avoids the

“pseudo-relaxation phenomenon” and allows for better classification of

the type of achalasia.

He also makes a good point about why you want to find a good radiology

center that does a lot of esophageal studies for the barium test, and

not just use the low volume local community center. The false negative

detection rate for achalasia in community hospitals is " 36%–50% " ,

compared to accuracy of " over 90% when performed in esophageal centers

of excellence. "

Another thing the article makes clear is that the 15-20mm dilatation

that is often done during the first EGD endoscopy is diagnostic, not

just hopeful treatment. If it works it is likely the problem is not

achalasia. If it does not work at all the likelihood of achalasia is

increased. I think it is unfortunate that this is not clearer to patient

who often think it was treatment for achalasia and that dilation does

not work for them, when in fact a dilatation with a real achalasia

dilator 30-40mm, or a series of them, may give years of effective

treatment that could compare to the results of a myotomy.

notan