Medical treatment of esophageal achalasia

Triadafilopoulos, George; Aaronson, Michael J.; Sackel, Stephen G.; Burakoff, Robert

doi:10.1007/bf01318193

Cited by 76 publications

(24 citation statements)

References 16 publications

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“…Pharmacological treatment with nitrates or calcium antagonists has almost been abandoned due to its poor efficacy and significant side effects (8). Although Heller myotomy (HM) is the most definitive and successful treatment, it is an invasive procedure, and often leads to complications such as perforation, esophageal reflux, and stricture.…”

Section: Discussionmentioning

confidence: 99%

Peroral endoscopic myotomy versus pneumatic dilation for achalasia in patients aged = 65 years

Wang¹,

Tan²,

Lv³

et al. 2016

Rev Esp Enferm Dig

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Background and aim: Both peroral endoscopic myotomy (POEM) and pneumatic dilation (PD) has proved to be effective for treating achalasia in patients aged ≥ 65 years. However little is known about the comparison between POEM and PD. The aim of the study was to compare the safety and efficacy of POEM and PD for the treatment of achalasia in these patients.Methods: We retrospectively reviewed the medical records of patients aged 65 years-old or more who received POEM or PD for the treatment of achalasia at our hospital from January 2010 to December 2015, they were divided into the POEM group and the PD group. Demographics and data about safety and efficacy were collected retrospectively and compared between the two groups.Results: A total of 31 patients were enrolled, and 21 of them received POEM, while the other 10 received PD. The treatment success (Eckardt score ≤ 3) rate of POEM and PD at 3, 6, 12, 24 and 36 months after the treatment were comparable (p > 0.05). Treatment failure was noticed in 3 cases, 1 of them was in the POEM group and the other 2 in the PD group, there was no significant difference (p > 0.05). Multivariate analysis showed that sigmoid-type achalasia was a predictive factor of treatment failure. No severe complications were observed during operation and periodical follow-up.Conclusion: Short-term and intermediate efficacy of POEM and PD for treating achalasia in patients aged ≥ 65 years was comparable. A large scale, randomized study with long-term follow-up is necessary in order to make a definitive conclusion.

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Section: Discussionmentioning

confidence: 99%

Peroral endoscopic myotomy versus pneumatic dilation for achalasia in patients aged = 65 years

Wang¹,

Tan²,

Lv³

et al. 2016

Rev Esp Enferm Dig

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“…There is no convincing evidence for using any of these medications for short term relief of achalasia symptoms. [69][70][71][72][73][74][75][76][77][78][79][80][81][82][83] Recommendations: we recommend against the use of nitrates, calcium blockers or phosphodiesterase inhibitors treatment for symptomatic relief of achalasia. GRADE: low.…”

Section: The Eckardt Score Is a Simple Tool To Measure Symptom Severi...mentioning

confidence: 99%

The 2018 ISDE achalasia guidelines

Zaninotto

Bennett

Boeckxstaens

et al. 2018

Diseases of the Esophagus

250

218

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Achalasia is a relatively rare primary motor esophageal disorder, characterized by absence of relaxations of the lower esophageal sphincter and of peristalsis along the esophageal body. As a result, patients typically present with dysphagia, regurgitation and occasionally chest pain, pulmonary complication and malnutrition. New diagnostic methodologies and therapeutic techniques have been recently added to the armamentarium for treating achalasia. With the aim to offer clinicians and patients an up-to-date framework for making informed decisions on the management of this disease, the International Society for Diseases of the Esophagus Guidelines proposed and endorsed the Esophageal Achalasia Guidelines (I-GOAL). The guidelines were prepared according the Appraisal of Guidelines for Research and Evaluation (AGREE-REX) tool, accredited for guideline production by NICE UK. A systematic literature search was performed and the quality of evidence and the strength of recommendations were graded according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE). Given the relative rarity of this disease and the paucity of high-level evidence in the literature, this process was integrated with a three-step process of anonymous voting on each statement (DELPHI). Only statements with an approval rate >80% were accepted in the guidelines. Fifty-one experts from 11 countries and 3 representatives from patient support associations participated to the preparations of the guidelines. These guidelines deal specifically with the following achalasia issues: Diagnostic workup, Definition of the disease, Severity of presentation, Medical treatment, Botulinum Toxin injection, Pneumatic dilatation, POEM, Other endoscopic treatments, Laparoscopic myotomy, Definition of recurrence, Follow up and risk of cancer, Management of end stage achalasia, Treatment options for failure, Achalasia in children, Achalasia secondary to Chagas' disease.

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“…Nifedipine has been shown to induce long-term remission and even normalization of physiology in a minority of patients. Verapamil has been shown to decrease lower esophageal sphincter pressure, but did not demonstrate a relevant symptomatic improvement 20–23…”

Section: Pharmacologic Therapymentioning

confidence: 99%

Management of achalasia

L¹,

Chiaverina²,

Cacciotella³

et al. 2011

CEG

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Several theories on the etiology and pathophysiology of achalasia have been reported but, to date, it is widely accepted that loss of peristalsis and absence of swallow-induced relaxation of the lower esophageal sphincter are the main functional abnormalities. Treatment of achalasia often aims to alleviate the symptoms of achalasia and not to correct the underlying disorder. Medical therapy has poor efficacy, so patients who are good surgical candidates should be offered either laparoscopic myotomy or pneumatic balloon dilatation. Their own preference should be included in the decision-making process, and treatment should meet the local expertise with these procedures. Laparoscopic surgical esophagomyotomy is a safe and effective modality. It can be considered as initial management or as secondary treatment if the patient does not respond to less invasive modalities. Pneumatic dilatation has proven to be a safe, effective, and durable modality of treatment when performed by experienced individuals, and appears to be the most cost-effective alternative. For patients with multiple comorbidities and for elderly patients, who are not good surgical candidates, endoscopic injection of botulinum toxin should be considered a safe and effective procedure. However, its positive effect diminishes over time, and the need for multiple repeated sessions must be taken into consideration. In the management of patients with achalasia, nutritional aspects play an important role. When lifestyle changes are insufficient, it is necessary to proceed to percutaneous gastrostomy under radiological guidance. In the future, intraluminal myotomy or endoscopic mucosectomy will possibly be an option. Further studies are needed to investigate the role of immunosuppressive therapies in those cases in which an autoimmune etiology is suspected.

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Medical treatment of esophageal achalasia

Cited by 76 publications

References 16 publications

Peroral endoscopic myotomy versus pneumatic dilation for achalasia in patients aged = 65 years

Peroral endoscopic myotomy versus pneumatic dilation for achalasia in patients aged = 65 years

The 2018 ISDE achalasia guidelines

Management of achalasia

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