[Achalasia. Diagnosis and therapeutic effect evaluated by esophageal manometry].

Achalasia was diagnosed in 57 patients from 1982 through 1991. 13 patients were evaluated by manometry both before and after pneumatic dilatation of the sphincter. There were no serious complications. All but one patient experienced good symptomatic effect; one patient was operated after two ineffective dilatations. The tonus and length of the lower oesophageal sphincter decreased significantly, but dilatation did not improve the swallow-induced relaxation of the sphincter, nor peristalsis in the oesophageal body. In three randomly selected patients, transcutaneous nervous stimulation did not have any symptomatic effects, nor did it affect the motility pattern of the oesophagus. Pneumatic dilatation of the lower oesophageal sphincter is a safe and effective first-choice treatment for achalasia, with myotomy being reserved for patients whose symptoms are not relieved successfully after two dilatations.