Treatment of achalasia with pneumatic dilatations

Vantrappen, Gaston; Hellemans, J.; Deloof, W.; Valembois, P.; Vandenbroucke, J

doi:10.1136/gut.12.4.268

Cited by 195 publications

(85 citation statements)

References 12 publications

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“…28 The mean delay in diagnosis is 5 years (range, 2-7 years). [29][30][31][32][33][34][35] Howard et al 36 reported that 36.8% of achalasia patients had been treated for GERD. Additionally, Rosenzweig and Traube 9 showed that the initial diagnosis was achalasia in only 12 of out 25 achalasia patients, whereas the other 13 patients were diagnosed incorrectly.…”

Section: Attributing Factors For Diagnostic Delay In Achalasiamentioning

confidence: 99%

Is Gastroesophageal Reflux Disease and Achalasia Coincident or Not?

Jung

Park

2017

J Neurogastroenterol Motil

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Achalasia and gastroesophageal reflux disease (GERD) are on opposite ends of the spectrum of lower esophageal sphincter dysfunction. Heartburn is the main symptom of GERD. However, heartburn and regurgitation are frequently observed in patients who have achalasia. The diagnosis of achalasia might be delayed because these symptoms are misinterpreted as gastroesophageal reflux. Here, we reviewed the clinical characteristics of patients with the erroneous diagnosis of GERD who actually had untreated achalasia.

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Section: Attributing Factors For Diagnostic Delay In Achalasiamentioning

confidence: 99%

Is Gastroesophageal Reflux Disease and Achalasia Coincident or Not?

Jung

Park

2017

J Neurogastroenterol Motil

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“…Other complications of pneumatic dilation include development of intramural hematomas, esophageal mucosal tears, and diverticula at the gastric cardia [72] . Severe transient and intermittent postprocedural chest pain has been reported in approximately 15% of patients during the 24-48 h after dilation [73,74] . Although this symptom is disturbing, it is not harmful.…”

Section: Pneumatic Dilationmentioning

confidence: 99%

Achalasia: A review of Western and Iranian experiences

Mikaeli¹,

Islami²,

Malekzadeh³

2009

WJG

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Achalasia is a primary motor disorder of the eso phagus, in which esophageal emptying is impaired. Diagnosis of achalasia is based on clinical findings. The diagnosis is confirmed by radiographic, endoscopic, and manometric evaluations. Several treatments for achalasia have been introduced. We searched the PubMed Database for original articles and meta analyses about achalasia to summarize the current knowledge regarding this disease, with particular focus on different procedures that are used for treatment of achalasia. We also report the Iranian experience of treatment of this disease, since it could be considered as a model for mediumresource countries. Myotomy, particularly laparoscopic myotomy with fundoplication, i s t h e m o s t e ffe c t i ve t re a t m e n t fo r a c h a l a s i a . Compared to other treatments, however, the initial cost of myotomy is usually higher and the recovery period is longer. When performing myotomy is not indicated or not possible, graded pneumatic dilation with slow rate of balloon inflation seems to be an effective and safe initial alternative. Injection of botulinum toxin into the lower esophageal sphincter before pneumatic dilation may increase remission rates. However, this needs to be confirmed in further studies. Due to lack of adequate information regarding the role of expandable stents in the treatment of achalasia, insertion of stents does not currently seem to be a recommended treatment. In summary, laparoscopic myotomy can be considered as the procedure of choice for treatment of achalasia. Graded pneumatic dilation is an effective alternative when the performance of myotomy is not possible for any reason.

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“…Predictors of the best clinical outcomes after PD include: age older than 40 years, women, LES pressure after dilatation <10 mmHg and type II pattern by HRM (14,23,45,46).…”

Section: Pneumatic Dilationmentioning

confidence: 99%

High Resolution Manometry - A Mandatory Examination in the Pre and Postoperative Assessment of Patients with Achalasia

Dimitriu¹,

Gheorghe²

2018

chr

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RezumatManometria esofagiană cu rezoluţie înaltă este actual investigaţia gold-standard în diagnosticul acalaziei şi a bolilor esofagiene funcţionale. Această examinare este întotdeauna precedată de endoscopia digestivă superioară, care are scopul de a face diagnosticul diferenţial al acalaziei cu pseudoacalazia (formaţiuni tumorale de fornix gastric/esofag distal). La momentul actual, nu există tratament curativ pentru acalazie. Însă, cele 3 subtipuri de acalazie (conform clasificării Chicago) au răspuns diferit în ceea ce priveşte eficacitatea în tratamentului ales. Astfel, comparativ cu tipurile I şi III, tipul II de acalazie are cel mai bun răspuns la intervenţiile terapeutice invazive (dilatare pneumatică sau cardiomiotomie Heller). În schimb, în tipul III cardiomiotomia Heller este de ales ca prima abordare terapeutică. Miotomia endoscopică perorală (POEM) este o tehnică relativ recentă, care necesită însă studii pe termen lung în ceea ce priveşte siguranţa şi eficacitatea. Articolul prezent îşi propune să prezinte variantele actuale de tratament ale acalaziei, comparându-le pe baza eficacităţii şi siguranţei pe termen scurt şi lung, subliniind de asemenea rolul manometriei cu rezoluţie înaltă în diagnosticul, alegerea metodei terapeutice şi prognosticul acestor pacienţi. Review ArticleAbstract High resolution manometry (HRM) is currently the gold standard for the diagnosis of achalasia and other functional esophageal disorders. All patients accusing dysphagia should be endoscopically evaluated prior to manometric investigations in order to rule out pseudoachalasia. The Chicago HRM classification has led to a subclassification of three manometric types of achalasia that seem to have different results to treatment. None of the actual achalasia treatment options are curative. Type II achalasia patients respond best to all treatment options compared to those with types I and III. Pneumatic dilation (PD) or Heller miotomy (LHM) can be both chosen as initial therapy in type I and II as they have good outcome , while type III achalasia patients respond better to LHM as a first therapeutic option. Peroral endoscopic myotomy (POEM) is a promising new technique but long-term follow-up studies for its safety and efficacy must be performed. This article reviews the current therapeutic options in achalasia and other functional esophageal disorders, based on the differences in safety and efficacy between approaches, highlighting the impact of HRM to predict the outcome but also the role of the techinque in guiding antireflux surgery.

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Treatment of achalasia with pneumatic dilatations

Cited by 195 publications

References 12 publications

Is Gastroesophageal Reflux Disease and Achalasia Coincident or Not?

Is Gastroesophageal Reflux Disease and Achalasia Coincident or Not?

Achalasia: A review of Western and Iranian experiences

High Resolution Manometry - A Mandatory Examination in the Pre and Postoperative Assessment of Patients with Achalasia

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