Prognosis
There is no known cure for achalasia. Treatment is purely symptomatic, aimed at improving oesophageal emptying and reducing dysphagia. Oesophageal peristalsis remains absent, swallowing never returns totally to normal, and the patient can only swallow while upright.
In one prospective 10-year follow-up study, endoscopic pneumatic dilatation for achalasia was associated with remission rates of 85.7% (6-36 months), 61.9% (37-60 months), and 40% (>60 months).[48] Mean 5- and 10-year remission rates in excess of 75% have been reported following laparoscopic cardiomyotomy.[51]
One randomised trial demonstrated a 2-year success rate of 92% with per-oral endoscopic myotomy (POEM), compared with 54% with pneumatic dilatation, in treatment-naive patients with achalasia.[50] Data on longer-term outcomes with POEM are currently lacking.
Health-related quality of life usually remains reduced, with a degree of persistent dysphagia, chest pain, or reflux symptoms.[77] Many patients may require long-term proton pump inhibitor therapy for symptomatic reflux or erosive oesophagitis after POEM.
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