scholarly journals Advances in the diagnosis and treatment of achalasia of the cardia: A review

2021 ◽  
Vol 9 (1) ◽  
pp. 24-31
Author(s):  
Baozhen Zhang ◽  
Yidan Wang ◽  
Ye Liao ◽  
Jingjing Zhang ◽  
Yufan Wu ◽  
...  
Keyword(s):  
Lower Esophageal Sphincter ◽  
Peroral Endoscopic Myotomy ◽  
Diagnosis And Treatment ◽  
Pneumatic Dilation ◽  
Motor Disorder ◽  
Sphincter Pressure ◽  
Idiopathic Achalasia ◽  
Retrosternal Pain ◽  
Endoscopic Myotomy ◽  
Esophageal Sphincter

Abstract Idiopathic achalasia is an esophageal motor disorder characterized by the loss of the lower esophageal sphincter ganglion, resulting in impaired lower esophageal relaxation and absence of esophageal peristalsis. Patients commonly present with progressive dysphagia accompanied by reflux, heartburn, retrosternal pain, and severe weight loss. Diagnosis is primarily based on the patient’s chief complaints, barium esophagography, and the most recent high-resolution manometry. Endoscopic assessment and endoscopic ultrasonography also have significant value with regard to the exclusion of esophageal anatomical lesions, neoplastic diseases, and pseudoachalasia. However, as most patients with achalasia demonstrate a gradual onset, early diagnosis is difficult. Currently, treatment of idiopathic achalasia, including pneumatic dilation, stent placement, and surgical myotomy, is aimed at reducing lower esophageal sphincter pressure and relieving the symptoms of dysphagia. Peroral endoscopic myotomy has gradually become the mainstream treatment because it causes less trauma and has a rapid recovery rate. This article reviews the main methods of diagnosis and treatment of achalasia, with an emphasis on the potential of peroral endoscopic myotomy and the advancements of immunotherapy for achalasia.

Achalasia: Diagnosis, Management, and Clinical Course in 16 Children

PEDIATRICS ◽  
1983 ◽  
Vol 71 (5) ◽  
pp. 798-805
Author(s):  
William E. Berquist ◽  
William J. Byrne ◽  
Marvin E. Ament ◽  
Eric W. Fonkalsrud ◽  
Arthur R. Euler
Keyword(s):  
Lower Esophageal Sphincter ◽  
Initial Treatment ◽  
Esophageal Manometry ◽  
Heller Myotomy ◽  
Lower Esophageal Sphincter Pressure ◽  
Pneumatic Dilation ◽  
Sphincter Pressure ◽  
School Aged Children ◽  
Retrosternal Pain ◽  
Esophageal Sphincter

Clinical features, radiographic and esophageal manometry findings, and treatment results in 16 patients less than 15 years old with achalasia are described. Esophageal manometry performed in 15 patients showed results similar to those found in adults: (1) increased resting lower esophageal sphincter pressure, (2) incomplete or failure of relaxation of the lower esophageal sphincter on swallowing, and (3) ineffective or absence of peristalsis in all. The most common symptoms in the 16 patients were: dysphagia in 15, postprandial vomiting in 13, and retrosternal pain in five. The average duration from onset of symptoms to diagnosis was 28 months. The esophagram was diagnostic in all patients. Pneumatic dilation was the initial treatment in eight and was successful for more than 1 year in five. Two patients required two dilations and were then symptom-free for more than 1 year, but required a Heller myotomy. The remaining patients underwent Heller myotomy following failure of the second dilation. Three patients underwent myotomy and two patients had myotomy with fundoplication as initial treatment; only one remained symptomatic. Esophageal dilation using a pneumatic dilator should be the initial treatment of choice in school-aged children. However, if more than two dilations are required within 1 year, surgical management is recommended.

Effects of Peroral Endoscopic Myotomy on Esophageal Function in the Treatment of Achalasia

2020 ◽  
pp. 155335062091313
Author(s):  
Bai Cang Zou ◽  
Li Zhang ◽  
Bin Qin ◽  
Shen Hao Wang ◽  
Yan Cheng ◽  
...  
Keyword(s):  
Stent Implantation ◽  
Clinical Symptoms ◽  
Operation Time ◽  
Peroral Endoscopic Myotomy ◽  
Esophageal Stent ◽  
Sphincter Pressure ◽  
Esophageal Function ◽  
Eckardt Score ◽  
Endoscopic Myotomy ◽  
Esophageal Sphincter

Peroral endoscopic myotomy (POEM) is a new technique to treat achalasia, but the effects on esophageal motor function and structure are still unclear. This study aimed to examine the esophageal function and anatomical changes of patients with achalasia treated with POEM. This was a retrospective study of 43 patients with achalasia treated with POEM between January 2013 and January 2016 at the Second Affiliated Hospital of Xi’an Jiaotong University. The patients were grouped as previous treatments for achalasia (n = 19) versus no previous treatment (n = 24). Surgical success (defined as Eckardt score ≤3 points or decreased by >3 points compared with baseline), recurrence, and reintervention were analyzed. Three patients (7.0%) were Eckardt grade I, 16 (37.2%) were grade II, and 24 (55.8%) were grade III. Operation time was 35 to 150 (median = 49) minutes. Both groups showed improvements in the Eckardt score after surgery (both P < .001), without a difference between the 2 groups ( P = .749). The maximal mean diameter of the esophagus was reduced, and the lower esophageal sphincter pressure was improved after surgery (both groups, all P < .001), without difference between the 2 groups (all P > .05). One case of failure was probably due to the presence of an esophageal stent. POEM has a high success rate and is possibly unaffected by previous treatments, except maybe stent implantation. Clinical symptoms of achalasia are significantly relieved by POEM; the function of the esophageal sphincter and the esophagus structure are improved. Previous esophageal stent implantation could increase failure likelihood, but this will have to be confirmed.

Su1483 Lower Esophageal Sphincter Pressure Six Months After Transesophageal Totally Endoscopic Myotomy for Achalasia

2011 ◽  
Vol 73 (4) ◽  
pp. AB278-AB279
Author(s):  
Abraham Mathew ◽  
Ozanan R. Meireles ◽  
Sheetal Nijhawan ◽  
Saniea F. Majid ◽  
Takayuki Dotai ◽  
...  
Keyword(s):  
Lower Esophageal Sphincter ◽  
Lower Esophageal Sphincter Pressure ◽  
Sphincter Pressure ◽  
Endoscopic Myotomy ◽  
Esophageal Sphincter

Tu1188 A Meta-Analysis of Prospective Trials: Lower Esophageal Sphincter Pressures in Adult Achalasia Patients Managed With Peroral Endoscopic Myotomy (POEM)

2017 ◽  
Vol 85 (5) ◽  
pp. AB575
Author(s):  
Abhiram Duvvuri ◽  
Vishnu Moole ◽  
Anwesh Poosala ◽  
Raghuveer R. Boddireddy ◽  
Achuta Uppu ◽  
...  
Keyword(s):  
Lower Esophageal Sphincter ◽  
Meta Analysis ◽  
Peroral Endoscopic Myotomy ◽  
Prospective Trials ◽  
Endoscopic Myotomy ◽  
Esophageal Sphincter

scholarly journals Novel technique to relax the lower esophageal sphincter during challenging peroral endoscopic myotomy (POEM)

Endoscopy ◽  
2016 ◽  
Vol 48 (S 01) ◽  
pp. E252-E252
Author(s):  
Majidah Bukhari ◽  
Vivek Kumbhari ◽  
Yamile Haito-Chavez ◽  
Yen-I Chen ◽  
Saowanee Ngamruengphong ◽  
...  
Keyword(s):  
Lower Esophageal Sphincter ◽  
Peroral Endoscopic Myotomy ◽  
Novel Technique ◽  
Endoscopic Myotomy ◽  
Esophageal Sphincter
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