Treatment of achalasia

Abstract

Achalasia is a primary motility disorder of the esophagus that causes dysphagia. Normal esophageal motility and lower esophageal sphincter (LES) function can not be restored; thus treatment is directed at decreasing the pressure or disrupting the muscle fibers of the LES to allow passage of ingested material. Effective therapy for achalasia can be broadly characterized as surgery based or endoscopy based. Medications (calcium channel blockers and nitrate derivatives) do not provide adequate relief of dysphagia and have substantial side effects, and thus are rarely used as long-term therapy. Botulinum toxin injection, a recently introduced endoscopic therapy, enjoyed much enthusiasm initially but was shown to have only transient effect and is now recommended only for poor operative candidates. The mainstay of therapy remains endoscopic dilation or laparoscopic esophagomyotomy (LEM) combined with an antireflux procedure. We have found that patients who can tolerate a laparoscopic abdominal surgery are best served with an LEM and Toupet (270 degrees ) posterior fundoplication. This provides good or excellent relief of dysphagia in 90% to 95% of patients with very little morbidity.

Laparoscopic Heller Myotomy and Dor Fundoplication: Prospective Evaluation of 30 Consecutive Patients

“…The surgery became satisfactory when the minimally invasive techniques were developed in the early 1990s. The hospital stay and postoperative pain were less in minimally invasive approach with symptomsas relief as amount as open surgery (13)(14)(15)(16)(17). Nowadays, there are several methods for surgical treatment of achalasia, such partial fundoplication, Toupet method (180 degree posterior fundoplication), myotomy without fundoplication et cetera.…”

Surgical Treatment of Achalasia: Transabdominal Versus Transthoracic Cardiomyotomy

“…They believe that surgery is indicated only in the failure of these approaches. 1,6) Surgical treatment of Achalasia was preformed by heller with transabdominal anterior & posterior cardio myotomy of LES. In 1958, Ellis treated Achalasia with a transthoracic technique [7][8][9] ; recently, laparoscopic myotomy with partial fundoplication is performed.…”

Brittleness of diabetes due to achalasia cardia managed successfully by multiple innovative strategies

“…[ 2 ] Other less effective therapeutic modalities include injection of botulinum toxin, nitrates and calcium channel blockers. [ 3 ] Long standing achalasia may lead to megaesophagus further worsening outcome. [ 3 ] Diabetes mellitus per se also can cause esophageal disorders namely reduced amplitude of esophageal contractions, reduced peristalsis, increased esophageal transit time and acid reflux due to the degeneration of autonomic nervous system.…”

“…[ 3 ] Long standing achalasia may lead to megaesophagus further worsening outcome. [ 3 ] Diabetes mellitus per se also can cause esophageal disorders namely reduced amplitude of esophageal contractions, reduced peristalsis, increased esophageal transit time and acid reflux due to the degeneration of autonomic nervous system. [ 4 ] Tight glycemic control can prevent these complications that are irreversible in nature.…”