| Abstract: | The aims of this study were to assess the effectof pneumatic dilation on gastroesophageal reflux inachalasia, differentiate esophageal acid due to lactatefrom acid due to gastroesophageal reflux, and determine if chest pain and heartburn arereliable indicators of gastroesophageal reflux. Eightuntreated achalasia patients underwent pre- andpostdilation esophageal fluid/food residue lactate andpH analysis, esophageal manometry, 24-hr pHmonitoring, and symptom assessment. All patients had asuccessful clinical outcome and a decrease in loweresophageal sphincter pressure from 29.1 ± 12.7 to14.7 ± 3.8 mm Hg (mean ± SD; P = 0.04). Abnormalacid exposure was present in two patients before and twopatients after dilation. Postdilation acid exposure wasmild. Lactate was detected before dilation in allpatients. A lactate concentration 2 mmol/liter wasassociated with acidic residue and one abnormal 24-hr pHprofile. There was no correlation between an abnormal24-hr pH test and age, lower esophageal sphincter pressure, or duration of symptoms prior totreatment. Chest pain and heartburn were unrelated todrops in pH. Gastroesophageal reflux is rare inuntreated achalasia and esophageal acidity may resultfrom ingestion of acidic foods or production oflactate. Mild gastroesophageal reflux occurs afterdilation but is of no clinical significance. Chest painand heartburn are not indicators of acid reflux inachalasia. |
