Achalasia

Boeckxstaens, Guy E.; Zaninotto, Giovanni; Richter, Joel E.

doi:10.1016/s0140-6736(13)60651-0

Cited by 487 publications

(418 citation statements)

References 131 publications

Supporting

Mentioning

387

Contrasting

Unclassified

Order By: Relevance

“…The end result is a degeneration of ganglion cells in the myenteric plexus of the esophageal body and the LES, creating an imbalance between the excitatory and inhibitory neurons (11)(12)(13)(14).…”

Section: Achalasiamentioning

confidence: 99%

“…Achalasia has no racial or gender predilection, the peak incidence being between 30 and 60 years (14).…”

Section: Achalasiamentioning

confidence: 99%

“…Patients usually presen with one or more of the following symptoms: long history of dysphagia for both solids and liquids, regurgitation of saliva or undigested food, chest pain, weight loss, heartburn or nocturnal cough (14). Heartburn and nocturnal cough can initially lead to a diagnosis of gastroesophageal reflux disease (GERD).…”

Section: Achalasiamentioning

confidence: 99%

“…Stages 0 and I indicated remission of the diseass, while stages II and III represented failure of treatment (15,16). The role of Eckhardt score in the evaluation of treatment efficacy significantly decreased during the last years, being replaced by more objective HR manometric parameters (14,15).…”

Section: Achalasiamentioning

confidence: 99%

“…Predictors of the best clinical outcomes after PD include: age older than 40 years, women, LES pressure after dilatation <10 mmHg and type II pattern by HRM (14,23,45,46).…”

Section: Pneumatic Dilationmentioning

confidence: 99%

See 4 more Smart Citations

High Resolution Manometry - A Mandatory Examination in the Pre and Postoperative Assessment of Patients with Achalasia

Dimitriu¹,

Gheorghe²

2018

chr

View full text Add to dashboard Cite

RezumatManometria esofagiană cu rezoluţie înaltă este actual investigaţia gold-standard în diagnosticul acalaziei şi a bolilor esofagiene funcţionale. Această examinare este întotdeauna precedată de endoscopia digestivă superioară, care are scopul de a face diagnosticul diferenţial al acalaziei cu pseudoacalazia (formaţiuni tumorale de fornix gastric/esofag distal). La momentul actual, nu există tratament curativ pentru acalazie. Însă, cele 3 subtipuri de acalazie (conform clasificării Chicago) au răspuns diferit în ceea ce priveşte eficacitatea în tratamentului ales. Astfel, comparativ cu tipurile I şi III, tipul II de acalazie are cel mai bun răspuns la intervenţiile terapeutice invazive (dilatare pneumatică sau cardiomiotomie Heller). În schimb, în tipul III cardiomiotomia Heller este de ales ca prima abordare terapeutică. Miotomia endoscopică perorală (POEM) este o tehnică relativ recentă, care necesită însă studii pe termen lung în ceea ce priveşte siguranţa şi eficacitatea. Articolul prezent îşi propune să prezinte variantele actuale de tratament ale acalaziei, comparându-le pe baza eficacităţii şi siguranţei pe termen scurt şi lung, subliniind de asemenea rolul manometriei cu rezoluţie înaltă în diagnosticul, alegerea metodei terapeutice şi prognosticul acestor pacienţi. Review ArticleAbstract High resolution manometry (HRM) is currently the gold standard for the diagnosis of achalasia and other functional esophageal disorders. All patients accusing dysphagia should be endoscopically evaluated prior to manometric investigations in order to rule out pseudoachalasia. The Chicago HRM classification has led to a subclassification of three manometric types of achalasia that seem to have different results to treatment. None of the actual achalasia treatment options are curative. Type II achalasia patients respond best to all treatment options compared to those with types I and III. Pneumatic dilation (PD) or Heller miotomy (LHM) can be both chosen as initial therapy in type I and II as they have good outcome , while type III achalasia patients respond better to LHM as a first therapeutic option. Peroral endoscopic myotomy (POEM) is a promising new technique but long-term follow-up studies for its safety and efficacy must be performed. This article reviews the current therapeutic options in achalasia and other functional esophageal disorders, based on the differences in safety and efficacy between approaches, highlighting the impact of HRM to predict the outcome but also the role of the techinque in guiding antireflux surgery.

show abstract

Section: Achalasiamentioning

confidence: 99%

“…Achalasia has no racial or gender predilection, the peak incidence being between 30 and 60 years (14).…”

Section: Achalasiamentioning

confidence: 99%

Section: Achalasiamentioning

confidence: 99%

Section: Achalasiamentioning

confidence: 99%

“…Predictors of the best clinical outcomes after PD include: age older than 40 years, women, LES pressure after dilatation <10 mmHg and type II pattern by HRM (14,23,45,46).…”

Section: Pneumatic Dilationmentioning

confidence: 99%

See 3 more Smart Citations

High Resolution Manometry - A Mandatory Examination in the Pre and Postoperative Assessment of Patients with Achalasia

Dimitriu¹,

Gheorghe²

2018

chr

View full text Add to dashboard Cite

show abstract

Peroral Endoscopic Myotomy (POEM) vs Pneumatic Dilation

Jacobson

Lichtenstein

2019

JAMA

View full text Add to dashboard Cite

Use and Safety of Per-Oral Endoscopic Myotomy for Achalasia in the US

et al. 2022

View full text Add to dashboard Cite

IMPORTANCE Several professional practice guidelines recommend per-oral endoscopic myotomy (POEM) as a potential first-line therapy for the management of achalasia, yet payers remain hesitant to reimburse for the procedure owing to unanswered questions regarding safety.OBJECTIVE To evaluate the use, safety, health care utilization, and costs associated with the use of POEM for treatment of achalasia relative to laparoscopic Heller myotomy (LHM) and pneumatic dilation (PD). DESIGN, SETTING, AND PARTICIPANTSThis was a retrospective national cohort study of commercially insured patients, aged 18 to 63 years, who underwent index intervention for achalasia with either LHM, PD, or POEM in the US between July 1, 2010, and December 31, 2017. Patient data were obtained from a national commercial claims database. Included in the study were patients with at least 12 months of enrollment after index treatment and a minimum of 6 months of continuous enrollment before their index procedure. Patients 64 years or older were excluded to avoid underestimation of health care claims from enrollment in Medicare supplemental insurance. Data were analyzed from July 1, 2019, to July 1, 2021. MAIN OUTCOMES AND MEASURESChanges in the proportion of annual procedures performed for achalasia were evaluated over time. The frequency of severe procedure-related adverse events, including perforation, pneumothorax, bleeding, and death, were compared. Negative binomial regression was used to compare the incidence rates of subsequent diagnostic testing, reintervention, and unplanned hospitalization. Generalized linear models were used to compare differences in 1-year health-related expenditures across procedures. RESULTSThis cohort study included a total of 1921 patients (median [IQR] age: LHM group, 48 [37-56] years; 737 men [51%]; PD group, 51 [41-58] years; 168 men [52%]; POEM group, 50 [40-57] years; 80 men [56%]). The use of POEM increased 19-fold over the study period, from 1.1% (95% CI, 0.2%-3.2%) of procedures in 2010 to 18.9% in 2017 (95% CI, 13.6%-25.3%; P = .01). Adverse events were rare and did not differ between procedures. Compared with LHM, POEM was associated with more subsequent diagnostic testing (incidence rate ratio [IRR], 2.2; 95% CI, 1.9-2.6) and reinterventions (IRR, 1.9; 95% CI, 1.1-3.3). When compared with PD, POEM was associated with more subsequent diagnostic testing (IRR, 1.5; 95% CI, 1.3-1.8) but fewer reinterventions (IRR, 0.4; 95% CI, 0.2-0.6). The total 1-year health care costs were similar between POEM and LHM, but significantly lower for PD

show abstract

Achalasia

Cited by 487 publications

References 131 publications

High Resolution Manometry - A Mandatory Examination in the Pre and Postoperative Assessment of Patients with Achalasia

High Resolution Manometry - A Mandatory Examination in the Pre and Postoperative Assessment of Patients with Achalasia

Peroral Endoscopic Myotomy (POEM) vs Pneumatic Dilation

Use and Safety of Per-Oral Endoscopic Myotomy for Achalasia in the US

Contact Info

Product

Resources

About