Pathogenesis, clinical manifestations, diagnosis, and treatment progress of achalasia of cardia

Li, Mingyue; Wang, Qinghua; Chen, Run-Peng; Su, Xiaofang; Wang, Dongyang

doi:10.12998/wjcc.v11.i8.1741

Cited by 8 publications

(10 citation statements)

References 80 publications

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“…The mean width of the esophageal lumen in patients with subtype 1 achalasia was 4.8 cm, with subtype 2 achalasia it was 5.0 cm and in patients with subtype 3 achalasia it was 5.8 cm. These data do not match the data from many studies, where a predominantly wider esophageal lumen was noted in subtype 1 [ 24 , 25 ]. The explanation for the literature-described dominance in the width of the lumen in subtype 1 is that in this subtype, aperistalsis is dominant due to the advanced stage of the disease and the accumulation of food and constant pressure on the esophageal wall, leading to dilatation.…”

Section: Discussioncontrasting

confidence: 99%

Achalasia Subtype Differences Based on Respiratory Symptoms and Radiographic Findings

et al. 2023

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Three subtypes of achalasia have been defined using esophageal manometry. Several studies have reported that symptoms are experienced differently among men and women, regardless of subtype. All subtypes could have some impact on the appearance of respiratory symptoms and lung complications due to compression of the trachea or aspiration of undigested food. The aim of this research was to analyze the differences in respiratory symptoms and radiographic presentation of lung pathology depending on the diameter and achalasia types. One or more respiratory symptoms were reported in 48% of 114 patients, and all of them had two or more gastrointestinal symptoms. The symptom score (SS) is statistically significant for the prediction of subtype 1 (area under the curve = 0.318; p < 0.001, cut-off score of 6.5 had 95.2% sensitivity) and subtype 2 (area under the curve = 0.626; p = 0.020, cut-off score of 7.5 had 93.1% sensitivity). The most common type was subtype 2 (50.8%), and although only 14 patients had subtype 3, they had the largest esophageal diameter (mean 5.8 cm). The difference in esophageal diameter was significant between subtype 1 and 3 (p = 0.011), subtype 2 and subtype 3 (p = 0.011). Nine patients (6%) had mega-esophagus (four patients in type 1, three in type 2 and two in type 3). More than half of all patients (51.7%) had at least one parenchymal lung change on CT scan. Recurrent micro-aspirations led to changes in the structure of the airways and lung parenchyma such as ground glass (GGO) and nodular changes (12%) and fibrosis (14.5%), and they had higher esophageal diameters (p < 0.001). Patients with chronic lung CT changes had significantly higher esophageal diameter than with acute changes (p < 0.001). Awareness of the association of achalasia and lung disorders is important in early diagnosis and treatment. More than half (57.5%) of patients with achalasia had some clinical and/or structural pulmonary abnormalities. All three subtypes had similar respiratory symptoms, meaning they cannot be used to predict the subtype of achalasia; on the contrary, SS can predict the first two subtypes. A higher diameter of the esophagus is associated with chronic structural lung changes. Although unexpected, the pathological radiological findings and diameter were significantly different in subtype 3 patients, but those parameters cannot lead us to a specified subtype.

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Section: Discussioncontrasting

confidence: 99%

Achalasia Subtype Differences Based on Respiratory Symptoms and Radiographic Findings

et al. 2023

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“…Management of achalasia involves improving the esophageal outflow in order to provide symptomatic relief to patients. The treatment modalities included pharmacologic therapy (calcium channel blocker, anticholinergic, and nitrates), endoscopic intervention (endoscopic botulinum toxin injection, per oral endoscopic myotomy, pneumatic dilation), and surgical interventions (laparoscopic Heller myotomy with partial fundoplication) [3 , 6 , 7] . Laparoscopic Heller myotomy is performed when drug treatment or endoscopic intervention fails to relieve symptoms [7] .…”

Section: Discussionmentioning

confidence: 99%

“…The treatment modalities included pharmacologic therapy (calcium channel blocker, anticholinergic, and nitrates), endoscopic intervention (endoscopic botulinum toxin injection, per oral endoscopic myotomy, pneumatic dilation), and surgical interventions (laparoscopic Heller myotomy with partial fundoplication) [3 , 6 , 7] . Laparoscopic Heller myotomy is performed when drug treatment or endoscopic intervention fails to relieve symptoms [7] . The safest and most effective treatment for achalasia is still surgery, which involves cutting the muscle fibers of the abnormally functioning lower esophageal sphincter (a Heller cardiomyotomy).…”

Section: Discussionmentioning

confidence: 99%

“…The etiology of achalasia is still vague, and its precise pathogenesis remains ambiguous to this day [3] , [4] , [5] . Histologic analysis reveals that achalasia is the result of the degeneration of ganglion cells in the myenteric plexus of the esophageal body and the lower esophageal sphincter [2 , 6 , 7] . The disorder is characterized by an impaired lower esophageal sphincter relaxation and the absence of esophageal peristalsis, resulting in esophageal outflow obstruction [1 , 4 , 5] .…”

Section: Introductionmentioning

confidence: 99%

“…Patients with suspected achalasia based on clinical presentation should always undergo an upper esophagogastroduodenoscopy to rule out pseudoachalasia from an obstructing mass. The diagnosis of achalasia is confirmed with high-resolution manometry, which is the current gold standard test [6 , 7] .…”

Section: Introductionmentioning

confidence: 99%

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