A critical appraisal and clinical application of Moonen A, Annese V, Belmans A, et al. Long-term results of the European achalasia trial: A multicentre randomised controlled trial comparing pneumatic dilation versus laparoscopic Heller myotomy. Gut. 2016 May;65(5):732-9. The patient is an 18-year-old African American female with a six month history of difficulty swallowing, both liquids and solids. The dysphagia has gotten progressively worse, to the point that over the last two months she has

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... een unable to swallow any liquids or solids, including water, without vomiting the contents back up within minutes. She has thus lost nearly 60 lbs over 6 months. She also had intermittent chest pain associated with the vomiting. She had two esophagogastroduodenoscopies (EGDs) since symptom onset that were suggestive of achalasia, but had poor follow-up and ultimately was admitted to the hospital due to malnutrition. Inpatient esophageal manometry confirmed the diagnosis of achalasia. A consult was placed to general surgery, and the surgery team indicated that the patient was a candidate for surgical treatment via Heller myotomy. Major surgery is a large decision for any patient, and especially so for a young adult, so other modalities were considered. Achalasia is also commonly treated with pneumatic balloon dilation of the lower esophageal sphincter, which was offered by the gastroenterology consult service. As a young female with most of her life ahead of her, our patient was interested in long-term solutions that would hopefully limit recurrent symptoms and the need for more procedures in the future. Clinical Question Does Heller myotomy for treatment of achalasia provide longer post-treatment periods without recurrent symptoms versus pneumatic balloon dilation, and reduce the need for future treatments, including subsequent balloon dilations? Research Article Moonen A, Annese V, Belmans A, et al. Long-term results of the European achalasia trial: A multicentre randomised controlled trial comparing pneumatic dilation versus laparoscopic Heller myotomy. Gut. 2016 May;65(5):732-9.