[Treatment of achalasia using balloon dilatation]. / Traitement de l'achalasie par dilatation pneumatique.

40 patients with achalasia underwent pneumatic dilatation. 25 were followed up for a mean duration of 3.96 years. Digestive symptoms disappeared in 32% of cases, were diminished in 40% and remained unchanged in 28%. In 8 patients oesophageal manometry after dilatation showed a significant reduction in lower oesophageal sphincter pressure. The patients showing improvement had a more marked drop in lower oesophageal sphincter pressure, lower residual pressure in the lower oesophageal sphincter measured by wet swallows, and negative pressure in the oesophagus. As complications 3 patients developed oesophageal perforation with one subsequent death, and 3 symptomatic gastro-oesophageal reflux. In view of these results, we regard pneumatic dilatation as the treatment of choice in achalasia.

[Questionable usefulness of the edrophonium test in the diagnosis of non-cardiac retrosternal pain]. / Utilité discutable du test à l'édrophonium dans le diagnostic d'une douleur rétrosternale non cardiaque.

Of 69 patients with non-cardiac chest pain, one third had abnormal esophageal motility as evidenced by basal esophageal manometry. 8 patients (12%) reported chest pain during a provocation test (edrophonium). While this pain seemed similar to the spontaneous chest pain described by 7 patients, it was not associated with manometric changes in 30% of these cases. The causal relationship between disorders of esophageal motility and non-cardiac chest pain has still to be confirmed, and caution must be exercised in interpreting edrophonium tests.