Achalasia: A review of therapeutic options and outcomes

Silveira, Eduardo B. V. Da; Rogers, Arvey I.

doi:10.1007/s12019-002-0038-4

Cited by 9 publications

(4 citation statements)

References 50 publications

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“…This review focuses on etiopathogenesis. The reader is referred to several excellent recent reviews on the diagnosis and treatment of achalasia 97–100 . Achalasia remains a rare but debilitating disease.…”

Section: Resultsmentioning

confidence: 99%

Achalasia: physiology and etiopathogenesis

Kraichely

Farrugia

2006

Diseases of the Esophagus

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Achalasia is a disorder of esophageal motility that has been well documented for over 300 years. Despite this, the initiating factor or factors and the underlying mechanisms leading to the characteristic features of achalasia, the absence of distal esophageal peristalsis and abnormal lower esophageal sphincter relaxation, are still not well understood. Recent work has shed light on changes in neurotransmission and cell signaling in the lower esophagus and lower esophageal sphincter that lead to achalasia. A number of recent reviews have thoroughly discussed diagnostic and therapeutic modalities and the reader is referred to these for in-depth review of these topics. The focus of this review will be on our current understanding of the physiology of esophageal peristalsis and lower esophageal sphincter function as it relates to achalasia and on available evidence for etiology and proposed pathophysiologic mechanisms.

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Section: Resultsmentioning

confidence: 99%

Achalasia: physiology and etiopathogenesis

Kraichely

Farrugia

2006

Diseases of the Esophagus

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“…Pharmacological therapy such as calcium channel blockers is less effective and often useless [7], but can provide palliation while the patient awaits the definitive procedure or if there is clinically significant concomitant comorbidity precluding esophageal dilatation or surgery [8,9].…”

Section: Introductionmentioning

confidence: 99%

Meta-Analysis of Randomized and Controlled Treatment Trials for Achalasia

Wang

2008

Dig Dis Sci

131

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Pharmacological therapy, botulinum toxin injection, pneumatic dilatation, and surgical myotomy are the primary therapeutic modalities for achalasia, for which laparoscopic myotomy is recommended as state-of-the-art therapy. However, its efficacy and safety remain unclear compared with other approaches in the treatment of achalasia. We searched electronic databases (MEDLINE, EMBASE, Cochrane Central Registry of Controlled Trials, LILACS-Latin American, Caribbean health science literature, and Science Citation Index Expanded) for randomized controlled trials to evaluate which therapeutic measures are temporary and reversible and which measures are definitive and effective by pooling data including remission rate, relapse rate, complications, and adverse effects. Seventeen studies with 761 patients met our inclusion criteria. There was better remission rate in pneumatic dilation than in botulinum toxin injection for initial intervention [relative risk (RR) 2.20, 95% confidence interval (CI) 1.51-3.20], Pneumatic dilation had lower relapse rate than did botulinum toxin injection (RR 0.12, 95% CI 0.04-0.32). Compared with pneumatic dilation, laparoscopic myotomy further increased remission rate (RR 1.48, 95% CI 1.48-1.87), and reduced clinical relapse rate (RR 0.14, 95% CI 0.04-0.58), and there was no difference in complication rate (RR 1.48, 95% CI 0.37-5.99). Based on limited randomized and controlled trials, laparoscopic myotomy is the preferred method for patients with achalasia. Future trials should investigate whether laparoscopic myotomy combined with different modalities of fundoplication is superior to isolated laparoscopic myotomy.

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“…Untreated, it leads to an extremely poor quality of life because of progressive dysphagia, esophageal dilation, and stasis [2] . Botulinum toxin (BoTx) injection of the LES, pneumatic dilation (PD) and Heller myotomy (HM) are the most commonly used techniques for the treatment of achalasia [3] . BoTx prompted a great deal of enthusiasm because it is safe, simple to use and can be easily repeated [4] .…”

Section: Introductionmentioning

confidence: 99%

A systematic review and meta-analysis of the Chinese literature for the treatment of achalasia

Wang

Li²,

Li³

et al. 2008

WJG

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AIM:To evaluate the effect of different approaches in the treatment of achalasia in China. METHODS:We performed a systematic review and meta-analysis of Chinese literature by searching the Chinese Biomedical Database and Chinese scientific Journals database (up to March 2008). All cohort studies (controlled or uncontrolled) in which the patients were observed for more than a year were reviewed in detail. Dichotomous outcomes were reported as relative risks (RR) with 95% confidence interval (CI) for controlled trials. The efficacy in uncontrolled trials was assessed by a pooled estimate of response rate with individual studies weighted in proportion to the sample size. RESULTS: Seven controlled trials compared the effect of botulinum toxin injection (BoTx) with pneumatic dilation (PD

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Achalasia: A review of therapeutic options and outcomes

Abstract: Advances in achalasia has led to the development of new therapeutic options. This review will focus on methodology and outcomes of two established techniques; pneumatic dilation and surgical myotomy; and one new technique, LES injection of botulinum A toxin.

Cited by 9 publications

References 50 publications

Achalasia: physiology and etiopathogenesis

Achalasia: physiology and etiopathogenesis

Meta-Analysis of Randomized and Controlled Treatment Trials for Achalasia

A systematic review and meta-analysis of the Chinese literature for the treatment of achalasia

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