Hong Kong Med J 2010;16:362–6 | Number 5, October 2010
Ten-year review of epidemiology, clinical features, and treatment outcome of achalasia in a regional hospital in Hong Kong
KY Ng, KF Li, KH Lok, Lawrence Lai, CH Ng, KK Li, ML Szeto
Division of Gastroenterology and Hepatology, Department of Medicine and Geriatrics, Tuen Mun Hospital, Hong Kong
OBJECTIVE. To describe the epidemiology, clinical features, and treatment outcome of achalasia in Chinese patients.
DESIGN. Retrospective study.
SETTING. Major regional hospital, Hong Kong.
PATIENTS. Clinical records of patients with the diagnosis of achalasia from July 1997 to June 2007 were reviewed.
RESULTS. Thirty-two patients were diagnosed with achalasia during the study period. The mean age at diagnosis was 50 years (standard deviation, 20 years). The female-to-male ratio was 1.3:1. The main presenting symptoms were dysphagia (78%) and vomiting (50%). Nine laparoscopic and two open Heller's operations had been performed and 16 patients had undergone endoscopic dilatations. Four patients had botulinum toxin injection and four were taking calcium channel blocker (nifedipine) medications. Botulinum toxin injection and medical therapy had poor shortand long-term responses. Laparoscopic myotomy and pneumatic dilatation had comparable good short- and long-term responses.
CONCLUSION. Achalasia affected all age-groups but there was a peak at middle age. Pneumatic dilatation and Heller's myotomy (open or laparoscopic approach) appeared able to maintain longer symptom responses than medical therapy and botulinum toxin injection.
Key words: Cardia; Esophageal achalasia; Esophageal sphincter, lower; Laparoscopy; Treatment outcome
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