Ten-year review of epidemiology, clinical features, and treatment outcome of achalasia in a regional hospital in 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 short- and 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.