Heller's myotomy and pneumatic dilatation in the treatment of achalasia: a population-based case–control study assessing long-term quality of life

Long-term health-related quality-of-life (HRQL) outcomes have not been widely reported in the<br/>treatment of achalasia. The aims of this study were to examine long-term disease-specific and general HRQL in<br/>achalasia patients using a population-based case–control method, and to assess HRQL between treatment interventions.<br/>Manometrically diagnosed achalasia cases (n = 120) were identified and matched with controls (n = 115)<br/>using a population-based approach. Participants completed general (SF-12) and disease-specific (Achalasia Severity<br/>Questionnaire [ASQ]) HRQL questionnaires, as appropriate, in a structured interview. Mean composite scores<br/>for SF-12 (Mental Component Summary score [MCS-12] and Physical Component Summary score [PCS-12]) and<br/>ASQ were compared between cases and controls, or between intervention groups, using an independent t-test.<br/>Adjusted mean differences in HRQL scores were evaluated using a linear regression model. Achalasia cases were<br/>treated with a Heller’s myotomy (n = 43), pneumatic dilatation (n = 44), or both modalities (n = 33). The median<br/>time from last treatment to HRQL assessment was 5.7 years (interquartile range 2.4–11.5). Comparing achalasia<br/>patients with controls, PCS-12 was significantly worse (40.9 vs. 44.2, P = 0.01), but MCS-12 was similar. However,<br/>both PCS-12 (39.9 vs. 44.2, P = 0.03) and MCS-12 (46.7 vs. 53.5, P = 0.004) were significantly impaired in those<br/>requiring dual treatment compared with controls. Overall however, there was no difference in adjusted HRQL<br/>between patients treated with Heller’s myotomy, pneumatic dilatation or both treatment modalities. In summary,<br/>despite treatment achalasia patients have significantly worse long-term physical HRQL compared with population<br/>controls. No HRQL differences were observed between the treatment modalities to suggest a benefit of one<br/>treatment over another.