scholarly journals Achalasia: current therapeutic options

2017 ◽  
Vol 8 (6-7) ◽  
pp. 101-108 ◽  
Author(s):  
Zubin Arora ◽  
Prashanthi N. Thota ◽  
Madhusudhan R. Sanaka
Keyword(s):  
Esophageal Motility ◽  
Heller Myotomy ◽  
Symptomatic Relief ◽  
Treatment Options ◽  
Motility Disorder ◽  
Pneumatic Dilation ◽  
Esophageal Peristalsis ◽  
Esophageal Motility Disorder ◽  
Endoscopic Myotomy ◽  
Esophageal Sphincter

Achalasia is a chronic incurable esophageal motility disorder characterized by impaired lower esophageal sphincter (LES) relaxation and loss of esophageal peristalsis. Although rare, it is currently the most common primary esophageal motility disorder, with an annual incidence of around 1.6 per 100,000 persons and prevalence of around 10.8/100,000 persons. Symptoms of achalasia include dysphagia to both solids and liquids, regurgitation, aspiration, chest pain and weight loss. As the underlying etiology of achalasia remains unclear, there is currently no curative treatment for achalasia. Management of achalasia mainly involves improving the esophageal outflow in order to provide symptomatic relief to patients. The most effective treatment options for achalasia include pneumatic dilation, Heller myotomy and peroral endoscopic myotomy (POEM), with the latter increasingly emerging as the treatment of choice for many patients. This review focusses on evidence for current and emerging treatment options for achalasia with a particular emphasis on POEM.

Laparoscopic Heller Myotomy for Achalasia Technical Aspects

2018 ◽  
Vol 84 (4) ◽  
pp. 477-480 ◽  
Author(s):  
Francisco Schlottmann ◽  
Marco E. Allaix ◽  
Marco G. Patti
Keyword(s):  
Heller Myotomy ◽  
Symptomatic Relief ◽  
Treatment Options ◽  
Esophageal Achalasia ◽  
Laparoscopic Heller Myotomy ◽  
Partial Fundoplication ◽  
Esophageal Peristalsis ◽  
Esophageal Motility Disorder ◽  
Esophageal Sphincter ◽  
Esophageal Emptying

Esophageal achalasia is a primary esophageal motility disorder defined by the lack of esophageal peristalsis, and by a lower esophageal sphincter that fails to relax in response to swallowing. Patients’ symptoms include dysphagia, regurgitation, aspiration, heartburn, and chest pain. Achalasia is a chronic condition without cure, and treatment options are aimed at providing symptomatic relief, improving esophageal emptying, and preventing the development of megaesophagus. Presently, a laparoscopic Heller myotomy with a partial fundoplication is considered the best treatment modality. A properly executed operation is key for the success of a laparoscopic Heller myotomy.

scholarly journals Sa1256 A COST-EFFECTIVENESS ANALAYSIS OF TREATMENT OPTIONS FOR ACHALASIA: PNEUMATIC DILATION VS HELLER MYOTOMY VS PER-ORAL ENDOSCOPIC MYOTOMY

2020 ◽  
Vol 91 (6) ◽  
pp. AB134-AB135
Author(s):  
Thomas R. McCarty ◽  
Pichamol Jirapinyo ◽  
Lyndon James ◽  
Walter W. Chan ◽  
Christopher C. Thompson
Keyword(s):  
Cost Effectiveness ◽  
Heller Myotomy ◽  
Treatment Options ◽  
Pneumatic Dilation ◽  
Per Oral Endoscopic Myotomy ◽  
Endoscopic Myotomy ◽  
Per Oral

scholarly journals Surgical Treatment for Achalasia of the Esophagus: Laparoscopic Heller Myotomy

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
Gonzalo Torres-Villalobos ◽  
Luis Alfonso Martin-del-Campo
Keyword(s):  
Weight Loss ◽  
Surgical Treatment ◽  
Esophageal Manometry ◽  
Heller Myotomy ◽  
Laparoscopic Heller Myotomy ◽  
Motility Disorder ◽  
Pneumatic Dilation ◽  
Newly Diagnosed ◽  
Robot Assisted ◽  
Esophageal Motility Disorder

Achalasia is an esophageal motility disorder that leads to dysphagia, chest pain, and weight loss. Its diagnosis is clinically suspected and is confirmed with esophageal manometry. Although pneumatic dilation has a role in the treatment of patients with achalasia, laparoscopic Heller myotomy is considered by many experts as the best treatment modality for most patients with newly diagnosed achalasia. This review will focus on the surgical treatment of achalasia, with special emphasis on laparoscopic Heller myotomy. We will also present a brief discussion of the evaluation of patients with persistent or recurrent symptoms after surgical treatment for achalasia and emerging technologies such as LESS, robot-assisted myotomy, and POEM.

Tu1127 PERORAL ENDOSCOPIC MYOTOMY FOR PATIENTS WITH ESOPHAGEAL EPIPHRENIC DIVERTICULUM AND ESOPHAGEAL MOTILITY DISORDER

2019 ◽  
Vol 89 (6) ◽  
pp. AB570
Author(s):  
Shinwa Tanaka ◽  
Masato Kinoshita ◽  
Hiroya Sakaguchi ◽  
Hirofumi Abe ◽  
Ryusuke Ariyoshi ◽  
...  
Keyword(s):  
Esophageal Motility ◽  
Motility Disorder ◽  
Peroral Endoscopic Myotomy ◽  
Epiphrenic Diverticulum ◽  
Esophageal Motility Disorder ◽  
Endoscopic Myotomy

scholarly journals High Resolution Impedance Manometry: A Necessity or Luxury in Esophageal Motility Disorder?

2018 ◽  
Vol 19 ◽  
pp. 998-1003
Author(s):  
Han Sin Boo ◽  
Ian Chik ◽  
Chai Soon Ngiu ◽  
Shyang Yee Lim ◽  
Razman Jarmin
Keyword(s):  
High Resolution ◽  
Esophageal Motility ◽  
Motility Disorder ◽  
Esophageal Motility Disorder

scholarly journals Evaluation of Short-term Outcomes of Laparoscopic Heller Cardiomyotomy with Dor Fundoplication Versus Pneumatic Dilatation for Treatment of Achalasia

2020 ◽  
Author(s):  
Islam Khaled ◽  
Gad M. Behairy ◽  
Mohamed Saeed ◽  
Sara Abdulaziz ◽  
Leena S. Omar ◽  
...  
Keyword(s):  
Lower Esophageal Sphincter ◽  
Pneumatic Dilatation ◽  
Pneumatic Dilation ◽  
Dor Fundoplication ◽  
Therapeutic Success ◽  
Esophageal Motility Disorder ◽  
Eckardt Score ◽  
Esophageal Sphincter ◽  
Dor’S Fundoplication

Abstract Background: Achalasia is a rare esophageal motility disorder of unknown cause. However, the best treatment modality for achalasia is controversial. Treatment consists of disruption of the lower esophageal sphincter, classically either by endoscopic pneumatic dilation or laparoscopic Heller’s myotomy combined with an anti-reflux procedure. The study aim was to compare laparoscopic Heller cardiomyotomy plus Dor Fundoplication with pneumatic dilatation for treatment of achalasia.Methods: In this interventional study, we included 50 adult patients diagnosed as having achalasia by performing either a barium study or by the absence of peristalsis and impaired relaxation of the lower esophageal sphincter on esophageal manometry. The patients were randomly classified into two groups according to the intervention performed: pneumatic dilation or laparoscopic Heller’s cardiomyotomy with Dor’s fundoplication(LHCM). Follow-up evaluations were performed after 8 and 16 months.Results: In total, 50 patients with achalasia and an Eckardt symptom score > 3 were managed by two different interventions according to their groups.After 16 months of follow up the height of a barium-contrast column after 5 min was significantly lower in the LHCM group than in the pneumatic dilation group. There were no other statistically significant differences in the primary or secondary outcomes(Eckardt score, lower esophageal sphincter, and quality of life) between the two groups.Conclusion: After 16 months of follow-up, the rates of therapeutic success and number of complications were nearly similar between LHCM and pneumatic dilation. We conclude that either treatment is suitable as an initial treatment for achalasia.

scholarly journals Esophageal Manometry with Provocative Testing in Patients with Noncardiac Angina-Like Chest Pain

1991 ◽  
Vol 5 (2) ◽  
pp. 51-57 ◽  
Author(s):  
William G Paterson ◽  
Delia A Marciano-D’Amore ◽  
Ivan T Beck ◽  
Laurington R Da Costa
Keyword(s):  
Chest Pain ◽  
Esophageal Motility ◽  
Esophageal Manometry ◽  
Motility Disorder ◽  
Diffuse Esophageal Spasm ◽  
Esophageal Motility Disorder ◽  
Nutcracker Esophagus ◽  
Hypertensive Lower Esophageal Sphincter ◽  
Acid Perfusion ◽  
Provocative Testing

In a five year period 238 of 594 esophageal manometric studies performed in the authors’ laboratory were done on patients whose major reason for referral was noncardiac angina-like chest pain. Standard eophageal manometry was performed followed by an acid-antacid perfusion period (Bernstein test) and then subcutaneous bethanechol (80 μg/kg to a maximum of 5 mg) was adminstered. Baseline manometry was normal in 38% of patients and was diagnostic of ‘nutcracker’ esophagus, nonspecific esophageal motility disorder, diffuse esophageal spasm and isolated hypertensive lower esophageal sphincter in 24%, 19%, 16% and 3% of patients, respectively. Ninety-six of 238 patients (40%) experienced reproduction of their presenting angina-like chest pain during acid perfusion. In 80% of these patients there were associated esophageal motor abnormal ilies induced by the acid perfusion. Thirty-six of 212 (17%) experienced pain reproduction following the injection of bethanechol; however, 16 of these had already had their presenting chest pain reproduced during the acid perfusion study. In two-thirds of the patients with pain reproduction following bechanechol there was an associated bethanechol-induced esophageal motility disorder. Overall 49% of patients had their pain reproduced during provocative testing. The acid perfusion test reproduced the pain much more frequently than bethanechol simulation. This study reaffirms the value of esophageal manometry and provocative testing in this group of patients.

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