Achalasia - An Update

Abstract

Achalasia is an esophageal motility disorder of unknown cause, characterized by aperistalsis of the esophageal body and impaired lower esophageal sphincter relaxation. Patients present at all ages, primarily with dysphagia for solids/liquids and bland regurgitation. The diagnosis is suggested by barium esophagram and confirmed by esophageal manometry. Achalasia cannot be cured. Instead, our goal is to relieve symptoms, improve esophageal emptying and prevent the development of megaesophagus. The most successful therapies are pneumatic dilation and surgical myotomy. The overall success rate of graded pneumatic dilation is 78%, with women and older patients responding best. Laparoscopic myotomy, usually combined with a partial fundoplication, has an overall success rate of 87%. Young patients, especially men, are the best candidates for surgical myotomy. Botulinum toxin injection into the lower esophageal sphincter and smooth muscle relaxants are usually reserved for older patients or those with co-morbid illness. The prognosis for achalasia patients to return to near normal swallowing is good, but the disease is rarely "cured" with a single procedure and intermittent touch-up procedures may be required.

Achalasia Is Associated With eNOS4a4a, iNOS22GA, and nNOS29TT Genotypes: A Case-control Study

“…1 Its pathogenesis is still enigmatic. [2][3][4] Genetic factors are likely to be important in its pathogenesis as supported by occasional familial aggregation, concordance among monozygotic twins and reports on association between achalasia and Hirshsprung's disease, a similar condition with genetic basis.…”

Is Heller Myotomy Better than Balloon Dilation? A Meta-Analysis

“…However, EBD is the most cost-effective treatment for achalasia for a period of 5 to 10 years after the procedures [13,31]. The most serious complication is perforation, which occurred in about 1-3% of the cases [5,11], and 50% of those patients required surgical intervention [12]. Other complications following pneumatic dilation are usually minor (mucosal tear, fever, bleeding, chest pain) [32].…”

“…The goals of the treatment for achalasia are to decrease the pressure of the LES, ameliorate the esophageal emptying and prevent the occurence of megaesophagus [5]. Various therapeutic facilities are available.…”

“…The typical symptoms of the patients with achalasia include dysphagia, regurgitation, weight loss, retrosternal chest pain and nocturnal coughing [7]. Therefore, treatment aims for achalasia include decreasing the pressure of the LES, ameliorating the esophageal emptying and preventing megaesophagus [5]. Pneumatic dilation and surgical myotomy are the most widely used treatment options for patients with achalasia.…”

“…Severe GERD is rare after pneumatic dilation. The most severe complication is perforation, which occurs in about 1-3% of the cases [5,11], 50% of cases requiring surgery [12]. Over a 5-10 year period the balloon dilation is the most cost-effective treatment for achalasia [13].…”