Compliance of the lower esophageal sphincter in patients with achalasia by the Endoflip technique

Achalasia is a rare motility disorder of the esophagus, with an incidence of 1
per 100.000. Although it is a rare disorder, it is commonly seen in specialized
academic centres.
Unexplained damage to the nerve endings in the esophagus leads to loss of
peristalsis and defective relaxation of the lower esophageal sphincter (LES).
The subsequent retention of foods and saliva in the esophagus leads to the
typical symptoms of achalasia: dysphagia, regurgitation of undigested food,
respiratory complications, chest pain and weight loss.
Treatment options for achalasia aim at reducing LES tone, and thereby relieving
of functional obstruction and improving the bolus transport across the LES. The
loss of esophageal peristalsis is irreversible.
The treatment option of preference is pneumodilation. Pneumatic dilation
therapy disrupts the LES by forceful inflation of an air-filled balloon, which
yields good results in up to 80% of patients. However, relapse rates are high,
and as achalasia is a lifelong disorder, patients are treated multiple times
frequently.
EndoFLIP is a diagnostic tool for assessing the competence of the esophageal
gastric junction (EGJ), by challenging its compliance. The prototype of the
Endoflip was used in our lab to assess the compliance of the EGJ before and
after eradacation of Barrett*s epithelium.
Esophageal manometry combined with symptom scores are used to decide whether
new treatment is indicated. Frequently patients have low residual LES pressure
during esophageal manometry, but experience daily dysphagia. Especially after
first dilation there is no good quantification of LES function, as scarring
takes place. Scarring leads to an impaired compliance and thereby dysphagia,
but this cannot be measured by LES pressure.

The aim of this study is to assess the compliance of the EGJ in patients with
achalasia and to compare this to LES pressure and the dysphagia score. We
hypothesize that compliance measurement of the EGJ by endoflip in achalasia can
warrant us extra information on the EGJ. Eventually that can guide the decision
on further treatment.

Prospective validation of a new diagnostic entity.

Risk of the procedure is limited. The procedure is unpleasant, but well
tolerated. Eventually the research can lead to a better measurement of LES
function in patients with achalasia.