Achalasia 2016: Treatment Alternatives

Herbella, Fernando A. M.; Moura, Eduardo Guimarães Hourneaux de; Patti, Marco G.

doi:10.1089/lap.2016.0468

Cited by 11 publications

(10 citation statements)

References 49 publications

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“…The selection of the best initial approach for achalasia also appears to be influenced by the Chicago Classification subgrouping. While in types I and II, more conservative treatments such as pneumatic dilatation and surgical myotomy appear to be good options, type III seems to be better managed with per oral endoscopic myotomy than surgical myotomy, probably due to the ability to perform longer myotomies 7 , 11 .…”

Section: Resultsmentioning

confidence: 99%

Evaluation of Esophageal Achalasia: From Symptoms to the Chicago Classification

Neto

Herbella

Schlottmann³

et al. 2018

ABCD, arq. bras. cir. dig.

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Introduction: The diagnosis of achalasia may be suggested by clinical features but a complete work-up is required not only to confirm the diagnosis but also to grade the disease by severity or clinical subtype. Objective: To review the current evaluation of esophageal achalasia and its correct comprehension. Method: The literature review was based on papers published on Medline/Pubmed, SciELO and Lilacs, crossing the following headings: “esophageal achalasia”; “deglutition disorders”; “diagnostic techniques”, “digestive system”; “endoscopy, digestive system”; “manometry”. Results: The diagnosis of achalasia is suggested by clinical features but is not sufficient to distinguish this from other esophageal disease. It must be confirmed by further diagnostic tests, such as esophagogastroduodenoscopy, barium swallow and manometry. Recent advances in diagnostic methods, including high resolution manometry might even help predicting outcome or selected more appropriate procedures to treat the disease. Conclusion: A detailed and systematic study of achalasia patients allows not only a correct diagnosis but also contributes to therapeutic decision making and prognosis.

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Section: Resultsmentioning

confidence: 99%

Evaluation of Esophageal Achalasia: From Symptoms to the Chicago Classification

Neto

Herbella

Schlottmann³

et al. 2018

ABCD, arq. bras. cir. dig.

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“…In addition to medical treatment, possible treatments for type III achalasia, distal esophageal spasm, and jackhammer esophagus include pneumatic esophageal dilation, peroral endoscopic myotomy, and Heller myotomy . However, there is insufficient evidence for favoring one treatment over the other, and hence the treatment of esophageal motility disorders remains challenging .…”

Section: Summary Of Studies Using Phosphodiesterase‐5 Inhibitors (Pdementioning

confidence: 99%

Phosphodiesterase inhibitors are viable options for treating esophageal motility disorders: A case report and literature review

Miller

Averbukh

Kwon

et al. 2019

J of Digest Diseases

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While there are several medical and surgical interventions for the treatment of esophageal motility disorders, treatment decisions can be controversial due to limited randomized controlled clinical trials.Phosphodiesterase type 5 (PDE5) inhibitors, indicated for the treatment of erectile dysfunction and pulmonary hypertension, can be utilized off-label to treat esophageal motility disorders. The aim of this case report and literature review is to highlight and support the use of PDE5 inhibitors as an option in the treatment of esophageal motility disorders before more invasive interventions are considered. Unfortunately, insurance coverage for the use of PDE5 inhibitors is often denied due to lack of supporting evidence for their efficacy or because of the government regulations set by the Centers for Medicare and Medicaid Services. 1 J Dig Dis. 2019;20:495-499. wileyonlinelibrary.com/journal/cdd 495 monly studied agent, sildenafil, beginning roughly 15 minutes after the administration and lasting roughly 1 hour in duration. 15 Tadalafil, on the other hand, was found to have a significantly longer half-life of 18 hours and provided symptom relief for almost 48 hours postadministration of medication. 20 However, the onset of action was prolonged, at roughly 45 minutes. Safety and adverse events were not closely investigated in these mentioned studies though a mild headache was the most common reported side effect. Interestingly, gastroesophageal reflux disease, an expected side effect from the relaxation of the LES, was not a common complaint. 22 In a retrospective study, Kim et al investigated sildenafil-induced esophageal symptoms in 300 patients taking sildenafil for erectile dysfunction. 25 In total 84 (28%) patients reported adverse effects, the two most common being facial flushing and headache. However, these esophageal symptoms developed sporadically and lasted less than 1 hour, and no patients discontinued the medication due to adverse effects. In a double-blind, placebo-controlled study, Galiè et al investigated the use of sildenafil in patients with pulmonary artery hypertension (PAH) and reported side effects. 26 The most common side effects were headache (95/207), flushing (24/207), and dyspepsia (24/207), and most were considered mild or moderate in severity. Additionally, the authors found no evidence of a relationship between dosage of sildenafil and tolerability in the 12-week study arm. Kim et al and Galiè et al have shown that sildenafil is well tolerated, without serious adverse side effects in patients with erectile dysfunction and PAH. However, caution must be exercised when extrapolating side effect profiles for patients with esophageal motility disorders.Motility disorders of the esophagus can be complex and progressive, and require the combination of clinical, endoscopic, and radiologic assessment for proper diagnosis. As seen in our patient, where motility testing alone did not identify features of classic type III achalasia, distal esophageal spasm, or jackhammer esophagus, barium swallo...

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“…9 The Chicago classification may help to predict the result of treatment. Pandolfino and colleagues 10 reported that type II achalasia patients were significantly more likely to respond to PD (91%) or LHM (100%), as compared to type I (56% overall) and type III (29% overall).…”

Section: Achalasiamentioning

confidence: 99%

Understanding the Chicago Classification: From Tracings to Patients

Schlottmann

Herbella

Patti

2017

J Neurogastroenterol Motil

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Current parameters of the Chicago classification include assessment of the esophageal body (contraction vigour and peristalsis), lower esophageal sphincter relaxation pressure, and intra-bolus pressure pattern. Esophageal disorders include achalasia, esophagogastric junction outflow obstruction, major disorders of peristalsis, and minor disorders of peristalsis. Sub-classification of achalasia in types I, II, and III seems to be useful to predict outcomes and choose the optimal treatment approach. The real clinical significance of other new parameters and disorders is still under investigation. (J Neurogastroenterol Motil 2017;23:487-494)

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Achalasia 2016: Treatment Alternatives

Cited by 11 publications

References 49 publications

Evaluation of Esophageal Achalasia: From Symptoms to the Chicago Classification

Evaluation of Esophageal Achalasia: From Symptoms to the Chicago Classification

Phosphodiesterase inhibitors are viable options for treating esophageal motility disorders: A case report and literature review

Understanding the Chicago Classification: From Tracings to Patients

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