A Controversy That Has Been Tough to Swallow: Is the Treatment of Achalasia Now Digested?

Abstract

Esophageal achalasia is a rare neurodegenerative disease of the esophagus and the lower esophageal sphincter that presents within a spectrum of disease severity related to progressive pathological changes, most commonly resulting in dysphagia. The pathophysiology of achalasia is still incompletely understood, but recent evidence suggests that degeneration of the postganglionic inhibitory nerves of the myenteric plexus could be due to an infectious or autoimmune mechanism, and nitric oxide is the neurotransmitter affected. Current treatment of achalasia is directed at palliation of symptoms. Therapies include pharmacological therapy, endoscopic injection of botulinum toxin, endoscopic dilation, and surgery. Until the late 1980s, endoscopic dilation was the first line of therapy. The advent of safe and effective minimally invasive surgical techniques in the early 1990s paved the way for the introduction of laparoscopic myotomy. This review will discuss the most up-to-date information regarding the pathophysiology, diagnosis, and treatment of achalasia, including a historical perspective. The laparoscopic Heller myotomy with partial fundoplication performed at an experienced center is currently the first line of therapy because it offers a low complication rate, the most durable symptom relief, and the lowest incidence of postoperative gastroesophageal reflux.

Fundoplication After Heller Myotomy: A Retrospective Comparison Between Nissen and Dor

“…Therefore, interpretation of the results and their validation to the general population must be considered carefully. This study confirms previously known results and its specific contribution is given by the evaluation of the two treatments effectiveness in patients with the rare condition of achalasia [9,10,[14][15][16][17][18][19][20][21][22][23][24][25].…”

“…Moreover, they contend that Dor fundoplication, providing the anchoring of the gastric fundus on the myotomy edges, ensures their proper opening and a correct healing, besides protecting the mucosa [9,10,[14][15][16][17][18][19][20][21][22][23][24][25].…”

“…Sir Thomas Willis in 1672 was the first to describe this condition in the medical literature and called it cardiospasm [1].…”

Esophageal Achalasia: Predictive Value of Preoperative Resting Pressure of LES Correlated with Type of Fundoplication

“…The most frequent postoperative complications are the recurrence of dysphagia and gastroesophageal reflux; the former is due to an incomplete myotomy, a fundoplication that is too tight, or a tight scar stricture, whereas the latter is due to an inefficient antireflux fundoplication [1,[15][16][17][18][19][20][21][22][23][24][25].…”

A Case of Achalasia With Acute Respiratory Insufficiency

“…Öte yandan AÖS komşuluğunda kalan distal özofageal kas dokusunun da etkilenmesiyle özofagus peristaltizmi de bozulmaktadır [3,4] . Motilite defekti ile AÖS'deki sürekli yüksek basınç-lı kontraksiyon; yutulan besin öğelerinin özofagus içinde birikmesine, mukozal irritasyon, regürjitas-yon ve uzun vadede AÖS'nin proksimalinde oluşan dilatasyon ile mega-özofagus oluşumuna yol aça-bilmektedir [5] . Masif şekilde dilate olan ve hava ile dolan distandü özofagusun havayoluna kompresyon uygulaması ile akut solunum yetmezliği gelişebil-mektedir [6] .…”