Barrett's Esophagus and Achalasia

Guo, Jinping; Gilman, Philip; Thomas, Rebecca; Fisher, Robert S.; Parkman, Henry P.

doi:10.1097/00004836-200204000-00011

Cited by 34 publications

(19 citation statements)

References 20 publications

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“…Results 251 patients were followed for a mean values of 8.4 years (range: . The average number of endoscopies with biopsy sample sets per patient was 4 (range: [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]. Three patients had no histological signs of oesophagitis throughout follow-up, 139 had oesophagitis grade 1, 49 oesophagitis grade 2 and 60 grade 3.…”

Section: Methodsmentioning

confidence: 99%

“…6 Complications of gastro-oesophageal reflux, such as Barrett's metaplasia and adenocarcinoma of the oesophagus in patients treated for achalasia are incidentally reported. [7][8][9] Patients with achalasia also have an increased risk of developing squamous cell carcinoma of the oesophagus. This is probably due to chronic inflammation and hyperplasia of the epithelium in response to stasis of food and fluid.…”

Section: -4mentioning

confidence: 99%

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Oesophagitis is common in patients with achalasia after pneumatic dilatation

Leeuwenburgh¹,

Dekken²,

Scholten³

et al. 2006

Aliment Pharmacol Ther

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Section: Methodsmentioning

confidence: 99%

Section: -4mentioning

confidence: 99%

Oesophagitis is common in patients with achalasia after pneumatic dilatation

Leeuwenburgh¹,

Dekken²,

Scholten³

et al. 2006

Aliment Pharmacol Ther

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“…First, development of Barrett's esophagus and even esophageal adenocarcinoma among untreated achalasia patients have been previously reported in the literature [10], which generally develop as a consequence of prolonged gastroesophageal reflux disease. Second, the coexistence of hiatal hernia and achalasia has already been described, and it is well known that hiatal hernia facilitates the development of GERD.…”

Section: Discussionmentioning

confidence: 99%

GERD: A Debated Background of Achalasia

Bognár¹,

Horváth²

2016

J Gastrointest Dig Syst

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Achalasia is a primary esophageal motility disorder of unknown etiology, characterized by aperistalsis of the esophageal body and impaired lower esophageal sphincter (LES) relaxation. Available data suggest that the disease is multifactorial, but the exact initiating factors that may play a role in the development of the disease remain unclear. Case presentation: We report the case of a 65 year-old woman who had typical reflux symptoms with heartburn and regurgitation for about seven years. During the year before her admission to our clinic her reflux symptoms resolved and dysphagia developed. Endoscopy revealed esophageal dilatation with erosive esophagitis, narrowed cardia and hiatal hernia. Barium swallow test, manometry and 24 hour pH monitoring confirmed the development of achalasia with accompanying gastroesophageal reflux disease (GERD). The patient underwent laparoscopic surgery, the hiatal hernia was reconstructed and a Heller's myotomy with a 360 degree Nissen fundoplication was performed. At the 3-year follow-up the patient was symptom free. Conclusion: Based on our experience and the review of the literature we believe that there is a cause-and-effect relationship between gastroesophageal reflux and the development of achalasia. In these cases a laparoscopic Heller's myotomy completed with a 360 degree Nissen fundoplication should be the recommended surgical treatment to minimize the possibility of postoperative reflux disease.

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“…As shown in Table 2, overall 14% of patients (range 5% to 55%) suffer from troubling heartburn, esophagitis, and peptic stricture, requiring PPIs. Barrett's esophagus and secondary adenocarcinoma of the esophagus have been reported after Heller myotomy [33]. The addition of an incomplete fundoplication decreases but does not eliminate reflux and its complications [28•].…”

Section: Heller Myotomymentioning

confidence: 99%

Modern management of achalasia

Richter

2005

Curr Treat Options Gastro

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The goals in the treatment of achalasia are threefold: 1) relieving the symptoms, particularly dysphagia and bland regurgitation; 2) improving esophageal emptying by disrupting the poorly relaxing lower esophageal sphincter (LES); and 3) preventing the development of megaesophagus. Although achalasia cannot be permanently cured, excellent palliation is available in over 90% of patients, especially those with pneumatic dilation and laparoscopic Heller myotomy. The efficacy for short- and long-term therapy seems to be similar when performed by experts. Pneumatic dilation done as an outpatient surgery disrupts the LES muscle from within by using balloons of progressively larger diameter (3.0, 3.5, and 4.0 cm). Repeat dilations may be required; secondary severe gastroesophageal reflux disease (GERD) is rare, but approximately 2% of patients will have an esophageal perforation. A surgical Heller myotomy is now being done laparoscopically through the abdomen that cuts the LES and extends the myotomy 2 to 3 cm onto the stomach. Usually 2 days of hospitalization is required, and patients can normally return to work in 1 to 2 weeks. Severe GERD with esophagitis and peptic stricture is a common complication; therefore, most surgeons combine the myotomy with an incomplete fundoplication. Medical therapy is much less effective than these invasive procedures. Smooth muscle relaxants (nitrates and calcium channel blockers) taken immediately before meals improve dysphagia, but side effects and drug tolerance are common. The injection of botulinum toxin (100 to 200 units) endoscopically into the LES gives short-term relief of symptoms and improves esophageal emptying. This treatment is most effective in the elderly, as symptom relief can last up to 1 to 2 years with a single injection. Several studies suggest the most cost-effective management of achalasia is initial treatment with pneumatic dilation.

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Barrett's Esophagus and Achalasia

Cited by 34 publications

References 20 publications

Oesophagitis is common in patients with achalasia after pneumatic dilatation

Oesophagitis is common in patients with achalasia after pneumatic dilatation

GERD: A Debated Background of Achalasia

Modern management of achalasia

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