OBJECTIVES: A rare disorder, achalasia, is managed with medications, botox, pneumatic dilatation (PD), or surgery. In regions like Pakistan, PD (first-line non-surgical treatment) is favored for its accessibility and cost-effectiveness as compared to specialized treatment modalities like POEM. In Pakistani referral center, the aim is to evaluate the efficacy of PD in treating subtypes of achalasia and determining the duration of asymptomatic status and clinical remission with quality-of-life (QoL) following one or more dilations.

METHODS: Between 2015 and 2024, 213 Achalasia patients were diagnosed through HRM at the Center for Liver & Digestive Diseases, Holy Family Hospital, Rawalpindi, Pakistan, out of which 191 patients were included due to opting PD and completing interviews using Eckardt and ASQ questionnaire for follow-ups up to 5 years. Data analysis was performed in SPSS version 25.0.

RESULTS: In a study of 191 patients (107 males, 84 females; mean age 41.84±16.5 years), 53% had one PD session, 30% had two, and 17% had three. Success rates were 58% for one PD, 78% for two, and 87.5% for three dilations, with no severe complications. The cumulative re-dilation rate was 20%, with a 76% success rate for repeat dilations. The remission probability of all subtypes ranged between 80-100% in one year, dropping to 10% in five years irrespective of type. Multiple PDs significantly outperformed single PDs (p=0.01), reducing the mean Eckardt score from 6.7 to 1.9 while QoL improved with successful dilations, but not for failed ones.

CONCLUSIONS: Our study supports initial dilatation effectively achieves long-term symptom relief and improved QoL with overall treatment potential for up to five years of symptom relief, offering valuable insights into the utility of Eckardt and ASQ questionnaires for assessing post-PD response in achalasia patients when other confirmatory tests were out of reach due to scarcity of expertise and resources in LMICs.