Achalasia: mechanisms underlying recurrent symptoms after treatment
Research type
Research Study
Full title
Achalasia: mechanisms underlying recurrent symptoms after treatment
IRAS ID
131305
Contact name
Daniel Sifrim
Contact email
Sponsor organisation
Barts Health NHS Trust
Clinicaltrials.gov Identifier
Research summary
Achalasia is a rare disorder of the oesophagus which causes difficulty swallowing (dysphagia) and regurgitation. It is characterized by a lack of peristalsis, non-relaxation of the lower oesophageal sphincter (LOS) (and often oesophageal shortening). Standard investigations for patients who have recurrence of symptoms after treatment in achalasia are high resolution oesophageal manometry (HRM) and a timed barium swallow/oesophagram (TBO).
A significant number of achalasia patients have recurrent dysphagia after an initial successful treatment. Potential pathophysiological factors responsible for symptom recurrence include persistent increased lower oesophageal sphincter pressure (i.e. failure of the sphincter to relax), decreased gastro-oesophageal junction (GOJ) distensibility and impaired oesophageal shortening. The correlation between severity of dysphagia after treatment and degree of impairment of each of these pathophysiological factors is unknown.
Many patients become less symptomatic or asymptomatic after re-treatment either with further pneumatic dilatations (PD) or Heller myotomy (HM). A few patients however remain symptomatic in spite of re-treatment. The impact of re-treatment on the underlying pathophysiological abnormalities associated with recurrent dysphagia is unknown.
GOJ distensibility and degree of oesophageal shortening can be tested by the techniques of EndoFLIP and intraluminal ultrsound (HFIUS). These physiological tests are described in the achalasia literature but are less widely used in clinical practice than HRM and TBO. We propose that investigating patients with achalasia (who have a recurrence of symptoms after treatment) using both standard and newer investigations will give an important insight into the pathophysiological abnormalities underlying such symptoms. Furthermore by following-up such patients after re-treatment to assess their degree of dysphagia (and potentially repeating the physiological tests) will assess if there is a correlation of physiological variables on outcome after re-treatment and the relationship between effect of re-treatment and correction of pathophysiological abnormalities
REC name
London - Brighton & Sussex Research Ethics Committee
REC reference
14/LO/0853
Date of REC Opinion
27 Jun 2014
REC opinion
Further Information Favourable Opinion