Factors that influence esophageal dilation in achalasia

Abstract

Abstract Megaesophagus is defined by esophageal diameter >6 cm and changes such as tortuosity and angulation. Timed barium swallow (TBS) is the best study to identify these changes. Megaesophagus occurs in the natural course of the disease, and patients without adequate treatment can develop progressive esophageal dilation but the factors that might contribute to the development of megaesophagus remain unknown. A retrospective study with a total of 110 patients diagnosed with achalasia and without any previous esophageal surgery. There were no significant differences between the megaesophagus (n=85) and non-megaesophagus (n=25) groups regarding age (40.4 vs. 40.9 yrs., p=0.87), gender (63% vs. 44% females, p=0.08), baseline weight (72.9 vs. 77.8 kg, p=0.20), EAT (30 vs 26.9, p=0.14), ECKARDT (9.2 vs 8.1, p=0.10), and GERD scores (23.4 vs. 24.8, p=0.62). However, there were significant differences between the group of esophageal dilation <6 cm and megaesophagus regarding symptom duration (23.2 vs 35.5 months, p=0.03), weight loss (13.7 vs. 9.7 kg, p=0.05), preoperative weight (59.2 vs. 68.1 kg, p=0.0058), dysphagia score (2.7 vs. 2.4, p=0.004), and baseline esophageal length (22.8 vs. 25.6 cm, p<0.0001). 16% of patients with megaesophagus had a duration of symptoms of only 12 months. In conclusion, patients with megaesophagus lost less weight in comparison to the <6 cm group. We found that patients with megaesophagus had a longer symptom duration. However, the symptom duration was not proportionally related to the degree of esophageal dilation. Furthermore, neither the degree of dysphagia nor weight loss positively correlated with the degree of esophageal dilation.