Current status of achalasia management: a review on diagnosis and treatment

Tuason, Joshua; Inoue, Haruhiro

doi:10.1007/s00535-017-1314-5

Cited by 57 publications

(48 citation statements)

References 63 publications

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“…Besides BD, other therapeutic possibilities are developing [27][28][29][30][31][32] but this method will remain the most convenient option for most patients.…”

Section: Discussionmentioning

confidence: 99%

Esophageal two-phase supine/standing scintigraphy and balloon dilatation in achalasia: 20 years of experience

et al. 2021

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Background/Aim. The purpose of this paper is to present the results of esophageal scintigraphy (ES) in achalasia treated by balloon dilatation (BD) for a long period of time between years 1997 and 2016 and to set parameters suitable for prediction of treatment outcomes. Methods. Two-phase ES in anterior projection was performed. The first phase involved swallowing 10 ml of water with 18.5 MBq 99m Tc in supine position. The second phase was performed in standing position after swallowing 100 ml of water. Retention index (RI) of esophageal radioactivity was calculated after the imaging using registered esophageal and gastric counts. ES was performed in 52 patients (34 male and 18 female, aged 22-75 years, median patient age of 44 years) before and after BD. In 32 patients only two scintigraphies were performed. In remaining 20 patients follow-up and repeated scintigraphies were continued including the patients with therapeutic failure and repeated BD. BD was repeated in 8 patients and those were followed up and evaluated over time.Modified BD was performed with Rigiflex balloon dilators. Results. Typical scintigraphic finding in supine position was passive esophageal filling without evidence of motility and in most of patients (43) absent radionuclide elimination to stomach (83%). Evaluating values before and longer after the first BD it has been shown that certain values of RI indicate remission or relapse of disease. The RI difference more than 50% after BD was a reliable indicator of longer remission The age and gender of patients had no impact on dilatation outcome but younger patients were with higher risk of early failure (6 patients during first year after BD). ES showed that the first BD was successful initially in 50 patients and after follow-up in 42 patients (81%). Conclusion. Two-phase supine/standing esophageal scintigraphy is most suitable for diagnosing and follow-up of achalasia.Retention index represents an important parameter for evaluation and prediction of therapeutic response. The RI difference more than 50% after BD is a reliable predictor of longer remission. Age and gender have no impact on dilatation outcome but patients younger than 40 years are with higher risk of early therapeutic failure.

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“…Besides BD, other therapeutic possibilities are developing [27][28][29][30][31][32] but this method will remain the most convenient option for most patients.…”

Section: Discussionmentioning

confidence: 99%

Esophageal two-phase supine/standing scintigraphy and balloon dilatation in achalasia: 20 years of experience

et al. 2021

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“…In the recent Chicago classification criteria of esophageal motility disorders, high-resolution manometry (HRM), which utilizes a transducer to continuously measure LES pressure, has been introduced and adopted (Bredenoord et al 2012;Muller 2015). Another report recommended performing upper endoscopy, HRM, barium swallow tests, and CT scans as routine screening examinations for patients with a clinical history suggestive of esophageal motility disorders (Tuason and Inoue 2017). Certainly, comprehensively performing these updated diagnostic examinations Table 2.…”

Section: Discussionmentioning

confidence: 99%

Importance of Barium Swallow Test and Chest CT Scan for Correct Diagnosis of Achalasia in the Primary Care Setting

Ishii

Akaishi

Abe

et al. 2019

Tohoku J. Exp. Med.

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Esophageal achalasia is a disease characterized by the impaired esophageal peristalsis and non-relaxation of the lower esophageal sphincter muscle with unknown causes. Clinical manifestation of the disease is nonspecific (e.g., weight loss, vomiting, and persistent cough); namely, early diagnosis of the disease is often difficult. Delayed diagnosis of the disease is known to impair the patients' quality of life. Identifying the diagnostic factors that could cause diagnostic delay is needed. In this study, we collected data from 38 patients with achalasia and searched for diagnostic factors associated with delayed diagnosis (i.e., ≥ 6 months from the first hospital visit to diagnosis). The enrolled patients, diagnosed with achalasia based on esophageal manometry findings, had undergone surgical myotomy. As a result, the diagnosis of achalasia was likely to be delayed when the physician who had first contacted the patient did not perform a barium swallow test (p < 0.0001) or chest CT scan (p < 0.01) in a timely fashion. Among the patients with a delayed diagnosis (n = 15), none underwent a barium swallow test or chest CT within 6 months from their first hospital visit. The estimated sensitivities of diagnostic examinations for achalasia based on the enrolled 38 patients were higher than 80% for the barium swallow test and chest CT scan, but only 50-81% for endoscopy. To avoid the delayed diagnosis of achalasia, performing a barium swallow test or chest CT scan in a timely fashion, in addition to routine endoscopy, appears to be highly important.

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“…4). EGJOO, the pathophysiology which is a loss or incomplete relaxation of the LES, can be treated using PD, LHM, or POEM [75].…”

Section: Pathophysiology-based Treatment Of Esophageal Spastic Disordersmentioning

confidence: 99%

Esophageal motility disorders: new perspectives from high-resolution manometry and histopathology

et al. 2017

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High-resolution manometry (HRM) and peroral endoscopic myotomy (POEM) have contributed significantly to the field of esophageal motility disorders in recent years. The development of HRM has categorized various esophageal motility disorders with a focus on a diverse range of manometric anomalies. Additionally, the Chicago classification criteria is widely used for manometric diagnosis. Moreover, POEM was introduced as a minimally invasive radical therapy for achalasia and shows promise for other spastic esophageal motility disorders as well. POEM has also enabled a transluminal endoscopic approach for determining the histology of the esophageal muscle layer, which is expected to assist in elucidating the etiology of disorders associated with esophageal motility. The purpose of this review is to update the diagnosis, pathology, and treatment of esophageal motility disorders, with a focus on the recent advances in this field.

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Current status of achalasia management: a review on diagnosis and treatment

Cited by 57 publications

References 63 publications

Esophageal two-phase supine/standing scintigraphy and balloon dilatation in achalasia: 20 years of experience

Esophageal two-phase supine/standing scintigraphy and balloon dilatation in achalasia: 20 years of experience

Importance of Barium Swallow Test and Chest CT Scan for Correct Diagnosis of Achalasia in the Primary Care Setting

Esophageal motility disorders: new perspectives from high-resolution manometry and histopathology

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