Review article: the management of achalasia – a comparison of different treatment modalities¹

Abstract

SUMMARY BackgroundAchalasia is an uncommon primary oesophageal motor disorder with an unknown aetiology. Therapeutic options for achalasia are aimed at decreasing the lower oesophageal sphincter pressure, improving the oesophageal empting, and most importantly, relieving the symptoms of achalasia. Modalities for treatment include pharmacologic, endoscopic, pneumatic dilatation and surgical. The decision of which modality to use involves the consideration of multiple clinical and economic factors.

A systematic review and meta-analysis of the Chinese literature for the treatment of achalasia

“…With the introduction of HM, there has been a change in the initial management approach to the treatment of achalasia. However, there is much controversy as to which treatment provides the best efficacy, sustained symptom relief and low complication rate [7] , especially in China [8] . Therefore, the aim of the present study was to evaluate the effects of different treatment modalities by reviewing the published trials in China.…”

Mediastinal Widening: An Unusual Presentation of Achalasia Cardia

“…Although an excess risk of carcinoma (standardized incidence ratio: 10.5, 95 % CI 7.0-15.9) has been observed in operated and nonoperated patients, making upper endoscopy a first line investigation in symptomatic relapse, guidelines do not support surveillance [2].…”

“…Esophageal manometry is key to diagnosis [1]. Treatment options are multiple, but randomized controlled trials are few, so decisions are based on local expertise, patient performance status and patient and physician preferences [1,2]. In those patients who fit and willing to undergo surgery either a pneumatic dilation protocol or a laparoscopic surgical myotomy with a partial funduplication as the first treatment are recommended.…”

“…Botulinum toxin injection, which is recommended in patients who are not good candidates for pneumatic dilation or surgery, is a safe procedure, but over 50% relapse after 6 months, requiring multiple injections. Pharmacological treatments (calcium channel blockers, phosphodiestetase-5-inhibitor,anticholinergic agents) are the last alternative, and is employed when dilation or surgery cannot be performed and when botulinum injection has failed [2][3][4].…”

Delayed presentation of intrathoracic esophageal perforation after pneumatic dilation for achalasia

“…Pneumatic dilation (PD) is considered to be the first line therapy for achalasia [3,4] . Esophageal perforation could be a hazardous event if left untreated after PD [5] .…”