Evaluating Long-Term Functional and Symptomatic Outcomes of Pneumatic Dilatation in Achalasia: An Experience from Pakistan

Achalasia, a rare esophageal motility disorder, is managed with medications, botulinum toxin, pneumatic dilation (PD), or surgery. In resource-limited settings like Pakistan, PD is preferred first-line non-surgical treatment due to its accessibility and cost-effectiveness so we aim to assess remission rates and clinical outcomes of PD.Between 2015 and 2024, 213 achalasia patients were diagnosed via HRM at Center for Liver & Digestive Diseases, Holy Family Hospital, Rawalpindi. 191 patients opted for PD and completed follow-up interviews using Eckardt score and ASQ questionnaire. Data analysis was performed using SPSS.Among 191 patients (107 males, 84 females), 53% underwent one, 30% two, and 17% three PD session. Success rates were 58% for one, 78% for two, and 87.5% for three sessions, with no severe complications. The cumulative re-dilation rate was 20%, with a 76% success rate for repeat dilations. Multiple PDs significantly outperformed single PDs(p=0.01), reducing mean Eckardt score from 6.7 to 1.9. QoL improved with successful dilations but not in failed cases.PD provides sustained symptom relief for up to five years, with repeat sessions enhancing long-term success, reinforcing PD as an effective, durable, and accessible treatment option for achalasia in low-resource settings for evidence-based clinical decision-making.