Outcomes of Treatment for Achalasia Depend on Manometric Subtype

Rohof, Wout O.; Salvador, Renato; Annese, Vito; Varannes, Stanislas Bruley des; Chaussade, Stanislas; Costantini, Mario; Elizalde, JI; Gaudric, M; Smout, A. J. P. M.; Tack, Jan; Busch, Olivier R.; Zaninotto, Giovanni; Boeckxstaens, Guy E.

doi:10.1053/j.gastro.2012.12.027

Cited by 394 publications

(351 citation statements)

References 18 publications

Supporting

Mentioning

324

Contrasting

Unclassified

Order By: Relevance

“…One of the original observations with the description of achalasia phenotypes was that treatment outcome was dependent on phenotype, with outcomes being best in type II and probably worst in type III 18 . Those observations have subsequently been confirmed by a number of other studies [21][22][23] (TABLE 3).…”

Section: Achalasia With Preserved Peristalsissupporting

confidence: 68%

“…However, that trial (and all preceding trials) did not consider achalasia subtypes in their design or in their assessment of treatment efficacy. Both the data in TABLE 3 and a subsequent reassessment of the European achalasia trial 23 suggest that achalasia subtypes are of great rele vance in terms of treatment effectiveness. Indeed, in the European achalasia trial, the efficacy of pneumatic dilation for treating type II achalasia was 100%, significantly better than LHM (93%, P = 0.03).…”

Section: Lhm and Pneumatic Dilationmentioning

confidence: 99%

“…3). In multiple reported HRM series from major centers worldwide, type II achalasia is the most common subtype 18,[21][22][23] . Paradoxically, type II achalasia would often go undetected or misdiagnosed with conventional manometry because of LES pseudo relaxation during pan-oesophageal pressurization, or because panoesophageal pressurization was mistaken for a spastic contraction, resulting in an alternative diagnosis of distal oesophageal spasm.…”

Section: Achalasia Phenotypesmentioning

confidence: 99%

“…Indeed, in the European achalasia trial, the efficacy of pneumatic dilation for treating type II achalasia was 100%, significantly better than LHM (93%, P = 0.03). By contrast, treatment success in type III achalasia was achieved (23) Pratap et al 22 51 PD 63% (24) 90% (24) 33% (3) Rohof et al 23 …”

Section: Lhm and Pneumatic Dilationmentioning

confidence: 99%

See 3 more Smart Citations

Advances in the management of oesophageal motility disorders in the era of high-resolution manometry: a focus on achalasia syndromes

Kahrilas

Bredenoord

Fox

et al. 2017

Nat Rev Gastroenterol Hepatol

View full text Add to dashboard Cite

High-resolution manometry (HRM), along with the analysis algorithms characterized in the Chicago Classification (CC) first proposed in 2008, have led to a major restructuring of the classification of oesophageal motility disorders. The inherently quantitative output of HRM devices fuelled enthusiastic expectation among motility experts that these advances would add a level of precision to the diagnosis of oesophageal motility disorders that was not previously possible. Nowhere was this advance more evident than in our concept of achalasia, now differentiated into subtypes as a direct result of HRM. Coincident with the assimilation of HRM into clinical practice was the development of a major therapeutic intervention for the management of oesophageal motility disorders, per-oral endoscopic myotomy (POEM). Not only does the POEM procedure provide a therapeutic option for myotomy with reduced morbidity relative to laparoscopic or open myotomy, but it also enables a calibrated intervention that is customized to patient-specific physiology. Together, these develop ments fostered an increasing emphasis on targeting therapy to specific aspects of oesophageal dysfunction, as measured by physiological testing, rather than discrete diagnoses. Again, nowhere is this evolution more evident than in our strategies for managing achalasia. This Consensus Statement examines the effect of HRM on our current understanding of oesophageal motility disorders with a focus on how this technology has affected the diagnosis, epidemiology and management of achalasia and achalasia-like syndromes. on behalf of the International Working Group for Disorders of Gastrointestinal Motility and FunctionAbstract | High-resolution manometry (HRM) and new analysis algorithms, summarized in the Chicago Classification, have led to a restructured classification of oesophageal motility disorders. This advance has led to increased detection of clinically relevant disorders, in particular achalasia. It has become apparent that the cardinal feature of achalasia -impaired lower oesophageal sphincter (LES) relaxation -can occur in several disease phenotypes: without peristalsis (type I), with pan-oesophageal pressurization (type II), with premature (spastic) distal oesophageal contractions (type III), or with preserved peristalsis (outlet obstruction). Furthermore, no manometric pattern is perfectly sensitive or specific for achalasia caused by a myenteric plexopathy, and there is no biomarker for this pathology. Consequently, physiological testing reveals other syndromes not meeting achalasia criteria that also benefit from therapies formerly reserved for achalasia. These findings have become particularly relevant with the development of a minimally invasive technique for performing a long oesophageal myotomy, the per-oral endoscopic myotomy (POEM). Optimal management is to render treatment in a phenotype-specific manner; that is, POEM calibrated to patient-specific physiology for spastic achalasia and the spastic disorders, and more conservative strategies...

show abstract

Section: Achalasia With Preserved Peristalsissupporting

confidence: 68%

Section: Lhm and Pneumatic Dilationmentioning

confidence: 99%

Section: Achalasia Phenotypesmentioning

confidence: 99%

Section: Lhm and Pneumatic Dilationmentioning

confidence: 99%

See 2 more Smart Citations

Advances in the management of oesophageal motility disorders in the era of high-resolution manometry: a focus on achalasia syndromes

Kahrilas

Bredenoord

Fox

et al. 2017

Nat Rev Gastroenterol Hepatol

View full text Add to dashboard Cite

show abstract

“…Predictors of the best clinical outcomes after PD include: age older than 40 years, women, LES pressure after dilatation <10 mmHg and type II pattern by HRM (14,23,45,46).…”

Section: Pneumatic Dilationmentioning

confidence: 99%

High Resolution Manometry - A Mandatory Examination in the Pre and Postoperative Assessment of Patients with Achalasia

Dimitriu¹,

Gheorghe²

2018

chr

View full text Add to dashboard Cite

RezumatManometria esofagiană cu rezoluţie înaltă este actual investigaţia gold-standard în diagnosticul acalaziei şi a bolilor esofagiene funcţionale. Această examinare este întotdeauna precedată de endoscopia digestivă superioară, care are scopul de a face diagnosticul diferenţial al acalaziei cu pseudoacalazia (formaţiuni tumorale de fornix gastric/esofag distal). La momentul actual, nu există tratament curativ pentru acalazie. Însă, cele 3 subtipuri de acalazie (conform clasificării Chicago) au răspuns diferit în ceea ce priveşte eficacitatea în tratamentului ales. Astfel, comparativ cu tipurile I şi III, tipul II de acalazie are cel mai bun răspuns la intervenţiile terapeutice invazive (dilatare pneumatică sau cardiomiotomie Heller). În schimb, în tipul III cardiomiotomia Heller este de ales ca prima abordare terapeutică. Miotomia endoscopică perorală (POEM) este o tehnică relativ recentă, care necesită însă studii pe termen lung în ceea ce priveşte siguranţa şi eficacitatea. Articolul prezent îşi propune să prezinte variantele actuale de tratament ale acalaziei, comparându-le pe baza eficacităţii şi siguranţei pe termen scurt şi lung, subliniind de asemenea rolul manometriei cu rezoluţie înaltă în diagnosticul, alegerea metodei terapeutice şi prognosticul acestor pacienţi. Review ArticleAbstract High resolution manometry (HRM) is currently the gold standard for the diagnosis of achalasia and other functional esophageal disorders. All patients accusing dysphagia should be endoscopically evaluated prior to manometric investigations in order to rule out pseudoachalasia. The Chicago HRM classification has led to a subclassification of three manometric types of achalasia that seem to have different results to treatment. None of the actual achalasia treatment options are curative. Type II achalasia patients respond best to all treatment options compared to those with types I and III. Pneumatic dilation (PD) or Heller miotomy (LHM) can be both chosen as initial therapy in type I and II as they have good outcome , while type III achalasia patients respond better to LHM as a first therapeutic option. Peroral endoscopic myotomy (POEM) is a promising new technique but long-term follow-up studies for its safety and efficacy must be performed. This article reviews the current therapeutic options in achalasia and other functional esophageal disorders, based on the differences in safety and efficacy between approaches, highlighting the impact of HRM to predict the outcome but also the role of the techinque in guiding antireflux surgery.

show abstract