Diagnosis and management of esophageal achalasia.

Abstract

Achalasia is a rare esophageal motility disorder that is usually idiopathic in origin. It is characterized by dysphagia, and patients often have chest pain, regurgitation, weight loss, and an abnormal barium radiograph showing esophageal dilation with narrowing at the gastroesophageal junction. Abnormal or absent esophageal peristalsis and impaired relaxation of the lower esophageal sphincter (LES) are typically seen on esophageal manometry. The advent of high resolution manometry (HRM) has allowed more precise diagnosis of achalasia, subtype designation, and differentiation from other esophageal motor disorders with an initial seminal publication in 2008 followed by further refinements of what has been termed the Chicago classification. Potential treatments include drugs, endoscopic botulinum toxin injection, balloon dilation, traditional surgery (usually laparoscopic Heller myotomy; LHM), and a novel, less invasive, natural orifice transluminal endoscopic surgery (NOTES) approach to Heller myotomy termed peroral endoscopic myotomy (POEM). The first human POEM was performed in 2008, with the first publication appearing in 2010 and evidence now rapidly accumulating showing POEM to be comparable to traditional surgery in terms of clinical success and radiologic and manometric post-therapy outcomes. This review discusses the diagnosis and management of achalasia with particular emphasis on the recent developments of HRM and POEM, which arguably represent the most important advances in the field since the advent of laparoscopic Heller myotomy in the 1990s.

• Authors: Stavros N Stavropoulos, David Friedel, Rani Modayil, Henry P Parkman
• Journal: BMJ (Clinical research ed.) (BMJ) Vol. 354 Pg. i2785 (Sep 13 2016) ISSN: 1756-1833 [Electronic] England
• PMID: 27625387 (Publication Type: Journal Article, Review)
• Copyright: Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Chemical References

• Botulinum Toxins

Topics

• Botulinum Toxins (administration & dosage)
• Chest Pain (etiology)
• Deglutition Disorders (etiology)
• Dilatation (methods)
• Esophageal Achalasia (complications, diagnosis, therapy)
• Esophageal Sphincter, Lower (diagnostic imaging, surgery)
• Humans
• Laparoscopy (methods)
• Manometry (methods)
• Natural Orifice Endoscopic Surgery (methods)
• Treatment Outcome
• Weight Loss