Achalasia: a critical review of epidemiological studies

Podas, T; Eaden, Jayne; Mayberry, Margaret K; Mayberry, J. F.

doi:10.1111/j.1572-0241.1998.00686.x

Cited by 87 publications

(26 citation statements)

References 7 publications

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“…Although PD improves EGJ distensibility, assessment of EGJ INTRODUCTION Achalasia is a primary esophageal motility disorder associated with functional obstruction at the level of the esophagogastric junction (EGJ) due to defective relaxation of the lower esophageal sphincter (LES). [1][2][3] Until recently, it was not possible to measure direct EGJ opening or EGJ distensibility. High-resolution manometry (HRM) and timed barium esophagogram measure surrogate parameters of EGJ opening, i.e., deglutitive EGJ relaxation pressure and bolus retention.…”

Section: Introductionmentioning

confidence: 99%

Esophagogastric junction distensibility in the management of achalasia patients: relation to treatment outcome

Smeets

Masclee

Keszthelyi

et al. 2015

Neurogastroenterology Motil

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Assessment of EGJ distensibility with the EndoFLIP technique is able to demonstrate the functional EGJ obstruction in newly diagnosed achalasia patients and EGJ distensibility differs between achalasia subtypes. Although PD improves EGJ distensibility, assessment of EGJ distensibility with a limited number of distension steps provides no additional information that is useful for clinical evaluation and management of achalasia patients.

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Section: Introductionmentioning

confidence: 99%

Esophagogastric junction distensibility in the management of achalasia patients: relation to treatment outcome

Smeets

Masclee

Keszthelyi

et al. 2015

Neurogastroenterology Motil

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“…Large centres dedicated to the research of achalasia have followed fewer than 300 patients 3–5 . Most clinical studies of achalasia have struggled in providing reliable epidemiologic data, as they were rarely able to recruit more than 50–100 patients into a single study 1, 2, 5–9 . Similarly, given these relatively small patient groups from individual tertiary care centres, the current practice patterns in the general management of achalasia have not been previously described in a representative population of achalasia patients.…”

Section: Introductionmentioning

confidence: 99%

Epidemiology and practice patterns of achalasia in a large multi-centre database

Enestvedt

Williams

Sonnenberg

2011

Alimentary Pharmacology &Amp; Therapeutics

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Background and Aims Because of its rarity, achalasia remains a difficult disease to study. The aim of the present analysis was to describe the epidemiology of achalasia and practice patterns in its endoscopic management, utilizing patient records from a large national database of endoscopic procedures. Methods The Clinical Outcomes Research Initiative (CORI) maintains a database of endoscopic procedures in diverse clinical practices. The data from 89 endoscopy practices distributed throughout the US during 2000–2008 were used to analyze the characteristics and therapy of patients with achalasia. Results Among 521,497 upper endoscopies during the study period, we identified 896 patients with achalasia. Compared with the entirety of all other endoscopic diagnoses, achalasia was more common in men than women (OR=1.39, CI 1.22–1.59), but similar among non-whites and whites (OR=0.87, CI 0.74–1.03). Relatively more achalasia patients were treated at university than community practices (OR=1.52, CI 1.30–1.78). Botox injection was most frequently used as first choice of endoscopic therapy in 41%, followed by balloon dilation in 21%, Savary dilation in 20%, Maloney dilation in 10%, Rigiflex in 4%, and other modalities in 4% of patients. One quarter of achalasia patients treated endoscopically underwent a repeat therapy about every 14 months. Conclusions Botox has become the primary choice of initial endoscopic therapy in achalasia. Despite their partial deviation from guidelines and recommendations, these endoscopic patterns reflect the current clinical practice in the United States.

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“…Achalasia is a rare motility disorder of the esophagus that affects 1 in every 100 000 individuals. 1 Treatment options for achalasia include medication, endoscopic balloon dilatation, injection of botulinum toxin, or surgery. Since 1966, we have performed fundic patch operations via a left thoracotomy, as developed by Thal and Hatafuku, 2 on 73 patients with achalasia.…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic Heller myotomy with Dor fundoplication for achalasia: long-term outcomes and effect on chest pain

Sasaki

Obuchi

Nakajima

et al. 2009

Diseases of the Esophagus

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The aim of the present study was to evaluate the long-term outcomes of laparoscopic Heller myotomy with Dor fundoplication (LHD) and its effect on chest pain. Between June 1995 and August 2009, a total of 35 patients with achalasia underwent an LHD. The symptom scores were calculated by combining the frequency and the severity. Pre- and postoperative evaluations included symptom score, radiology, manometry, and 24-hour pH manometry. Median total symptom score was significantly lower than the preoperative score (19 vs 4, P < 0.001) at a median follow-up of 94 months. Among the 35 patients, 18 (51%) had chest pain. The frequency of chest pain was similar for the pre- and postoperative scores, but the severity tended to be less. Median esophageal diameter (5.4 cm vs 3.5 cm, P < 0.001) and lower esophageal sphincter pressure (41 mmHg vs 8.9 mmHg, P < 0.001) were significantly reduced after surgery. Median age, duration of symptoms, esophageal diameter, and lower esophageal sphincter pressure were similar between patients with and without chest pain prior to surgery. No significant differences were observed between the two groups in terms of amplitude, duration, and frequency of contractions from the findings of postoperative 24-hour esophageal manometry. Chest pain resolved in three patients (17%) and improved in seven patients (39%) after surgery. LHD can durably relieve achalasic symptoms of both dysphagia and regurgitation, and it can be considered the surgical procedure of choice. However, achalasic chest pain does not always seem to be related with patient characteristics and manometric findings.

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Achalasia: a critical review of epidemiological studies

Cited by 87 publications

References 7 publications

Esophagogastric junction distensibility in the management of achalasia patients: relation to treatment outcome

Esophagogastric junction distensibility in the management of achalasia patients: relation to treatment outcome

Epidemiology and practice patterns of achalasia in a large multi-centre database

Laparoscopic Heller myotomy with Dor fundoplication for achalasia: long-term outcomes and effect on chest pain

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