Management of achalasia

Abstract

Several theories on the etiology and pathophysiology of achalasia have been reported but, to date, it is widely accepted that loss of peristalsis and absence of swallow-induced relaxation of the lower esophageal sphincter are the main functional abnormalities. Treatment of achalasia often aims to alleviate the symptoms of achalasia and not to correct the underlying disorder. Medical therapy has poor efficacy, so patients who are good surgical candidates should be offered either laparoscopic myotomy or pneumatic balloon dilatation. Their own preference should be included in the decision-making process, and treatment should meet the local expertise with these procedures. Laparoscopic surgical esophagomyotomy is a safe and effective modality. It can be considered as initial management or as secondary treatment if the patient does not respond to less invasive modalities. Pneumatic dilatation has proven to be a safe, effective, and durable modality of treatment when performed by experienced individuals, and appears to be the most cost-effective alternative. For patients with multiple comorbidities and for elderly patients, who are not good surgical candidates, endoscopic injection of botulinum toxin should be considered a safe and effective procedure. However, its positive effect diminishes over time, and the need for multiple repeated sessions must be taken into consideration. In the management of patients with achalasia, nutritional aspects play an important role. When lifestyle changes are insufficient, it is necessary to proceed to percutaneous gastrostomy under radiological guidance. In the future, intraluminal myotomy or endoscopic mucosectomy will possibly be an option. Further studies are needed to investigate the role of immunosuppressive therapies in those cases in which an autoimmune etiology is suspected.

Is Heller Myotomy Better than Balloon Dilation? A Meta-Analysis

“…Achalasia is a motility disorder of the esophagus characterized by degenerative changes of the myenteric plexus, which lead to a selective loss of inhibitory nerve endings [4]. The goals of the treatment for achalasia are to decrease the pressure of the LES, ameliorate the esophageal emptying and prevent the occurence of megaesophagus [5].…”

Achalasia Cardia: Revisited

“…32 Therefore, the esophagus should be checked every year or two with a timed barium swallow because some may need pneumatic dilatations, a repeat myotomy, or even esophagectomy after many years. In addition, some physicians recommend pH testing and endoscopy to check for reflux damage, which may lead to Barret's esophagus or a stricture if untreated.…”

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

“…Achalasia is a rare esophageal motility disorder 1,2 characterized by the disruption of the normal functioning of the esophageal peristaltic wave and of the lower esophageal sphincter 3 due to degenerative changes of the myenteric plexus. 1,3 This condition may occur at any age, with an increased incidence between the third and fifth decade, and shows no gender predilection.…”

“…1,3 This condition may occur at any age, with an increased incidence between the third and fifth decade, and shows no gender predilection. 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.…”

“…1,3 This condition may occur at any age, with an increased incidence between the third and fifth decade, and shows no gender predilection. 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.…”