Achalasia of the oesophagus in elderly patients responds poorly to conservative therapy

Abstract

In a retrospective study the symptoms and results of pneumatic dilatation in achalasia of the oesophagus were analysed in 11 patients (six women) aged 65 years and above (group 1) and compared with 19 younger patients (two women, group 2) over a 48-month period. Weight loss occurred in 91% of group 1 patients and 53% of group 2 patients. Pulmonary complications were commoner in group 1 than in group 2. All patients in group 1 and 84% of patients in group 2 complained of regurgitation. Lower oesophageal sphincter pressures were similar in the groups but the median diameter of the oesophageal body was greater in group 1 patients. The duration of dysphagia before presentation was longer in group 1 (median 5 years; range 1-9 years) compared with group 2 (median 2 years; range 0.5-4 years). None of the six elderly patients receiving pharmacological treatment with nifedipine or nitrates improved while five of the six younger patients treated with medications reported transient improvement. In group 1 only 50% of the pneumatic dilatations resulted in improvement and the median duration of improvement was 12 weeks. These results were significantly worse than those in group 2 where 90% of the dilatations resulted in improvement which lasted for a median duration of 52 weeks. Long-term results were satisfactory in six of the 11 elderly patients and 16 of the 19 younger patients.