Current Approach to the Treatment of Achalasia

Cheatham, Joseph G.; Wong, Roy K.H.

doi:10.1007/s11894-011-0190-z

Cited by 30 publications

(24 citation statements)

References 39 publications

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“…25 The main clinical observation of achalasia is dysphagia to solids and liquids; in people, symptoms also include chest pain, heartburn, and regurgitation. 12 Aspiration pneumonia is a common sequela, as is weight loss, although this typically manifests later in the disease process. Patients with chronic achalasia are also at increased risk of developing esophageal cancer, 8,25 likely due to food stasis leading to bacterial overgrowth and nitrosamine production that causes chronic inflammation and dysplasia.…”

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confidence: 99%

Megaesophagus in a Line of Transgenic Rats

et al. 2014

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Megaesophagus is defined as the abnormal enlargement or dilatation of the esophagus, characterized by a lack of normal contraction of the esophageal walls. This is called achalasia when associated with reduced or no relaxation of the lower esophageal sphincter (LES). To date, there are few naturally occurring models for this disease. A colony of transgenic (Pvrl3-Cre) rats presented with megaesophagus at 3 to 4 months of age; further breeding studies revealed a prevalence of 90% of transgene-positive animals having megaesophagus. Affected rats could be maintained on a total liquid diet long term and were shown to display the classic features of dilated esophagus, closed lower esophageal sphincter, and abnormal contractions on contrast radiography and fluoroscopy. Histologically, the findings of muscle degeneration, inflammation, and a reduced number of myenteric ganglia in the esophagus combined with ultrastructural lesions of muscle fiber disarray and mitochondrial changes in the striated muscle of these animals closely mimic that seen in the human condition. Muscle contractile studies looking at the response of the lower esophageal sphincter and fundus to electrical field stimulation, sodium nitroprusside, and L-nitro-L-arginine methyl ester also demonstrate the similarity between megaesophagus in the transgenic rats and patients with achalasia. No primary cause for megaesophagus was found, but the close parallel to the human form of the disease, as well as ease of care and manipulation of these rats, makes this a suitable model to better understand the etiology of achalasia as well as study new management and treatment options for this incurable condition.

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confidence: 99%

Megaesophagus in a Line of Transgenic Rats

et al. 2014

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“…Maksimak et al [9] reported 4 children treated with nifedipine before meals who reported relief of symptoms likely related to a decrease in resting LES pressure. In either children or adults, nifedipine is not a definitive therapy and should only rarely be used as a bridge to relieve symptoms until pneumatic dilatation, Botox injection or myotomy can be performed [5,10] .…”

Section: Medical Therapymentioning

confidence: 99%

Childhood achalasia: A comprehensive review of disease, diagnosis and therapeutic management

Franklin

Petrosyan

Kane

2014

WJGE

111

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Achalasia is an esophageal motility disorder characterized by failure of lower esophageal sphincter (LES) relaxation and is rare in children. The most common symptoms are vomiting, dysphagia, regurgitation, and weight loss. Definitive diagnosis is made with barium swallow study and esophageal manometry. In adults, endoscopic biopsy is recommended to exclude malignancy however; it is not as often indicated in children. Medical management often fails resulting in recurrent symptoms and the ultimate definitive treatment is surgical. Laparoscopic Heller myotomy with or without an anti-reflux procedure is the treatment of choice and has become standard of care for children with achalasia. Peroral endoscopic myotomy is a novel therapy utilized with increasing frequency for achalasia treatment in adults. More experience is needed to determine the safety, efficacy, and feasibility of peroral endoscopic myotomy in children.

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“…4 Typical symptoms are dysphagia for both solid and liquid food, chest pain, regurgitation 1,3 and in more advanced stages, loss of weight and malnutrition. Currently, the treatment is based on palliative options that reduce the pressure of lower esophageal sphincter (LES) 5 and relieves the main symptoms of achalasia.…”

Section: Introductionmentioning

confidence: 99%

Post-Surgical Quality of Life, Psychological State and what Patients Think about the Effectiveness of Heller Myotomy in the Treatment of Achalasia

Vale-Fonseca

Ferreira-Pinto²,

Figueiredo-Braga³

et al. 2016

Acta Med Port

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Introduction:The disruption of esophageal motility that characterizes achalasia typically provokes dysphagia, pain, loss of weight and malnutrition. Therefore, patients frequently report a reduction in quality of life and negative emotional states. Laparoscopic Heller myotomy proved to be an effective therapy, enabling the resumption of good quality of life. Material and Methods:The authors studied 45 patients previously submitted to laparoscopic Heller myotomy. Postoperative evaluation was performed using a customized version of the achalasia disease-specific quality of life questionnaire. Quality of life and the presence of depressive and anxiety symptoms were assessed using the Portuguese versions of the Medical Outcomes Study SF-36 and the Hospital Anxiety and Depression Scale. Conclusion:This study demonstrates that the Heller myotomy is associated with a good quality of life in patients with achalasia and strengthens the evidence that this is a safe and reliable procedure.

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Current Approach to the Treatment of Achalasia

Cited by 30 publications

References 39 publications

Megaesophagus in a Line of Transgenic Rats

Megaesophagus in a Line of Transgenic Rats

Childhood achalasia: A comprehensive review of disease, diagnosis and therapeutic management

Post-Surgical Quality of Life, Psychological State and what Patients Think about the Effectiveness of Heller Myotomy in the Treatment of Achalasia

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