Achalasia: What’s New in Diagnosis and Treatment?

Abstract

Achalasia is an esophageal motility disorder of unknown cause, characterized clinically by dysphagia and regurgitation and diagnosed by manometry and/or barium esophagogram. Good long-term symptomatic relief can be achieved with pneumatic dilatation and myotomy. Botulinum toxin injection and videoendoscopic surgery are being evaluated as less invasive forms of therapy.

Oesophagitis is common in patients with achalasia after pneumatic dilatation

“…Patients with achalasia tend to underreport their symptoms, because they are used to an often longstanding situation of dysphagia and interpret a slight improvement in oesophageal emptying as already a dramatic improvement. 3,18 Besides, many achalasia patients, especially those who are older have an altered vagal afferent response leading to a diminished perception of pain. 19,20 In order to detect inflammation, surveillance endoscopy with adequate biopsy sampling is necessary.…”

Predictors of a better outcome of pneumatic dilatation in patients with primary achalasia

“…Dysphagia, regurgitation, chest pain, and weight loss are among the most recognized clinical features of the disease [3,4]. The aim of therapy in patients with achalasia is to reduce distal obstruction, which can be treated by botulinum toxin injection, pneumatic dilatation (PD) or surgical esophagomyotomy [3].…”

Recurrent achalasia treated with Heller myotomy: A review of the literature

“…Treatment for achalasia includes drug therapy [3], botulinum toxin (BoTx) injection [4,5] , pneumatic dilatation (PD) [6,7] and Heller myotomy (HM) [8][9][10] . Among these, PD and HM are the most common treatment methods for untreated achalasia [11] . However, none of the treatments reverses the underlying neuropathology of achalasia.…”