Diagnosis and Management of Achalasia: Updates of the Last Two Years

Abstract

Achalasia is a rare neurodegenerative disorder causing dysphagia and is characterized by abnormal esophageal motor function as well as the loss of lower esophageal sphincter (LES) relaxation. The assessment and management of achalasia has significantly progressed in recent years due to the advances in high-resolution manometry (HRM) technology along with the improvements and innovations of therapeutic endoscopy procedures. The recent evolution of HRM technology with the inclusion of an adjunctive test, fluoroscopy, and EndoFLIP has enabled more precise diagnoses of achalasia to be made and the subgrouping into therapeutically meaningful subtypes. Current management possibilities include endoscopic treatments such as Botulinum toxin injected to the LES and pneumatic balloon dilation. Surgical treatment includes laparoscopic Heller myotomy and esophagectomy. Furthermore, in recent years, per oral endoscopic myotomy (POEM) has established itself as a principal endoscopic therapeutic alternative to the traditional laparoscopic Heller myotomy. The latest randomized trials report that POEM, pneumatic balloon dilatation, and laparoscopic Heller’s myotomy have comparable effectiveness and complications rates. The aim of the current review is to provide a practical clinical approach to dysphagia and to shed light on the most recent improvements in diagnostics and treatment of achalasia over the last two years.

Esophageal achalasia: An unusual reason for lung abscess

“…The most common symptoms are dysphagia for both solids and liquids, regurgitation, and chest pain 1 . In addition to Heller myotomy and esophagectomy, 2 POEM has been established as a principal endoscopic therapeutic procedure in recent years 2,3 . Esophageal achalasia induces lung abnormalities due to dilatation of the esophagus and recurrent microaspiration 4 .…”

“…1 In addition to Heller myotomy and esophagectomy, 2 POEM has been established as a principal endoscopic therapeutic procedure in recent years. 2,3 Esophageal achalasia induces lung abnormalities due to dilatation of the esophagus and recurrent microaspiration. 4 A previous report showed that 50% of patients with esophagus achalasia had evidence of lung lesions such as tracheo-bronchial compression by the dilated esophagus, ground-glass opacities, nodules, fibrosis, air trapping, consolidation, and bronchiectasis on CT. 4 Furthermore, esophageal achalasia causes aspiration pneumonia, which can be lead to lung abscess.…”

Advances on Neurogastroenterology and Motility Disorders: Pathophysiology, Diagnostics and Management

“…EndoFLIP may further help to measure secondary peristalsis in patients with esophageal symptoms, enabling the diagnosis of achalasia or other major esophageal motility disorders. Advances in fluoroscopy methodology, such as the timed barium swallow protocol and timed barium surface area measurement, have further added to the diagnostic arsenal when assessing a patient with esophageal symptoms [ 13 , 14 ].…”

A case of significant weight loss and severe malnutrition caused by achalasia

“…Achalasia is a dysphagia-causing neurodegenerative condition characterized by impaired esophageal motor function and a lack of lower esophageal sphincter (LES) relaxation. Achalasia is a relatively uncommon condition, with an annual incidence of 0.03-1.63/100,000 people and a prevalence of 10/100,000 [1]. Achalasia's specific pathophysiology is unknown at this time.…”