Pneumatic dilatation is a satisfactory first-line treatment for achalasia.

The results of 124 pneumatic dilatations done in 92 patients with achalasia cardia were assessed. Relief of dysphagia and other symptoms was obtained in 90 (97.8%) patients--in 68 (73.9%) after one dilatation, in 16 (17.8%) after two dilatations and in six (6.5%) after three dilatations. Two patients who did not obtain relief after three sittings of dilatation underwent surgery and both became totally asymptomatic thereafter. Most of the patients successfully treated with pneumatic dilatation remained asymptomatic during a follow up of 6 months--5 years. The few who did become symptomatic (8.01%) within a year after pneumatic dilatation responded well to the same procedure when repeated. Immediate and late complications of pneumatic dilatation occurred in 3.3% and 4.35% of patients respectively and were all medically manageable. In our assessment, pneumatic dilatation is a simple, quick, safe and effective method for treating achalasia. It should be used as the primary mode of treatment and surgery should be offered only to those patients who fail to respond to at least three attempts at pneumatic dilatation.