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Age, More Than Duration of Symptoms, Impacts Symptoms of Achalasia and Outcomes After Myotomy
Alexander Rosemurgy, Desiree Villadolid, Donald Thometz, Brian Boe, Steven Rakita, University of South Florida College of Medicine, Tampa, FL

Introduction:Duration and severity of symptoms determine the need for laparoscopic Heller myotomy. Presumably, prior to myotomy, duration and severity of symptoms will be inversely related and age will reflect duration of symptoms. This study was undertaken to determine the relationships among age, duration of symptoms, severity of symptoms, and outcome after laparoscopic Heller myotomy. 

Methods:262 patients, 54% male and 46% female, of average age 49 years ± 17, have undergone laparoscopic Heller myotomy and been prospectively followed. Patients scored the severity of their symptoms before and after myotomy using a Likert scale (0 = Never/Not Bothersome to 10 = Always/Very Bothersome). Data are presented as median, mean ± standard deviation. Follow-up is 25 months, 32 months ± 28.7. Results:After myotomy, patient symptom scores improved (p < 0.001 for all, paired Student's t-test) (Table). For choking and chest pain, the severity of premyotomy symptoms correlated with the severity of postmyotomy symptoms and outcome (p < 0.05 for all). By two-variable regression analysis, duration of symptoms had a significant relationship with age (p < 0.001), but not with severity of preoperative or postoperative symptoms or outcome. Conversely, age at myotomy correlated with severity of premyotomy regurgitation (p < 0.05), and the lack of postmyotomy choking (p < 0.01) and heartburn (p < 0.05), and superior outcomes (p < 0.05). As expected, outcome correlated with severity of postmyotomy symptoms (p < 0.05).  Conclusions:Laparoscopic Heller myotomy greatly reduces the severity of symptoms of achalasia. Older patients had suffered of achalasia longer, had more severe premyotomy symptoms, and had superior outcomes than younger patients. Duration of symptoms of achalasia alone did not correlate with severity, as expected; patients suffering achalasia for prolonged duration before myotomy did not have more severe symptoms. Age, more than duration of symptoms, impacts presenting symptoms of achalasia and outcomes after myotomy.

Symptom	Before Myotomy	After Myotomy
Dysphagia	10, 8 ± 3.0	1, 2 ± 2.5
Chest pain	5, 5 ± 4.0	0, 1 ± 2.1
Regurg.	9, 8 ± 3.0	0, 2 ± 2.8
Choking	10, 8 ± 3.2	1, 2 ± 2.7
Heartburn	4, 5 ± 3.9	1, 2 ± 1.5

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