Current clinical approach to achalasia

Table 2 Predictors of treatment response in achalasia

Treatment option	Positive predictors	Negative predictors
Botulinum toxin injection	Vigorous achalasia	Initial LES pressure ≥ 50% of the upper limit of normal
	Older patients	Lack of clinical response or residual LES pressure ≥ 18 mmHg after initial botulinum toxin treatment
Pneumatic dilatation	Older patients	Male Gender
		Pulmonary symptoms
		Failed response to 1-2 initial dilations
		High initial LES pressure (> 15-30 mmHg)1
		Reduction of LES pressure < 50% after the first dilation
Myotomy	Younger patients (< 40 yr)	Severe preoperative dysphagia
		Lower preoperative LES pressures of < 30-35 mmHg1
		Esophageal body dilation (flask type or sigmoid esophagus)
		Preoperative endoscopic treatment (in some studies)

¹Pressure values show considerable inter-study variability, depending on techniques used by different authors. Therefore, the pressure values shown in the table only reflect estimates based on the available literature.