Pattern and treatment outcome of patients with achalasia cardia after Modified Heller’s Myotomy: experience from Ethiopia

Abstract

Background: Although achalasia condition occurs in males and females with equal frequency, there are studies reporting that there is a male predominance even in Ethiopia. There appears to be striking international variations with significant differences between countries with respect to prevalence, occurrence in different sex and age groups and clinical features. The main objective of this study was to determine the pattern of clinical presentation and demographic characteristics and to assess the surgical treatment outcome of patients with achalasia. Methods: This was a 5-year retrospective review of medical records and theatre operation register notes of patients operated for achalasia of cardia  at Tikur Anbessa Specialized Hospital, Addis Ababa. Selected socio- demographic variables, clinical presentations, radiologic imaging, post-operative course and final outcome were recorded on a structured format. Data was entered, cleaned and edited using EPI info version 3.5.1 for windows and analyzed using SPSS version 15 for windows. Frequencies, percentages, Mann-Whitney U test and Chi-square test were applied to describe and compare the difference between sex, age and dysphagia scores. Wilcoxon Signed Ranks test was used to evaluate the surgical treatment outcome after patients underwent Modified Heller’s Myotomy (MHM). Results: A total of 46 patients’ records that were operated for achalasia were reviewed, of whom 56.5% were males, 52.2% were of younger age (52.2%) with a mean of 26.4 years (Range: 14 – 65 years). Thirty eight (82.6%) patients suffered from grade 3-4 dysphagia. Higher dysphagia score, with no significant statistical difference, was predominantly seen among the young (87.5%) and female (95%) patients. Severity of symptoms of dysphagia was significantly reduced after Modified Heller’s Myotomy (P<0.0001) Conclusion: Slight predominance of male sex and younger age group was found among patients operated for achalasia. Modified Heller’s Myotomy was found to be effective in alleviating symptoms of achalasia.