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Psychiatria Danubina Dec 2021Achalasia is a disorder characterized by insufficient relaxation of the lower esophageal sphincter and absent peristalsis. It is usually primary (idiopathic) achalasia,... (Review)
Review
Achalasia is a disorder characterized by insufficient relaxation of the lower esophageal sphincter and absent peristalsis. It is usually primary (idiopathic) achalasia, but it can also be secondary achalasia (pseudoachalasia). With a review of the literature, epidemiological data was gathered on achalasia in this paper, and followed up with presented etiopathogenetic mechanisms of achalasia. An optimal diagnostic algorithm along with the therapeutic possibilities in achalasia, from endoscopic to surgical methods of therapy, was analyzed. The most common causes of pseudoachalasia and the mechanisms of this disorder are reported. In patients with dysphagia and suspected achalasia, it is important to distinguish idiopathic achalasia from pseudoachalasia, since pseudoachalasia most often occurs due to tumor infiltrations of the lower esophageal sphincter. In this paper, the importance of a timely and accurate diagnosis of pseudoachalasia in relation to idiopathic achalasia was shown.
Topics: Esophageal Achalasia; Humans; Neoplasms
PubMed: 35150486
DOI: No ID Found -
World Journal of Surgery Jul 2022A precise diagnosis is key to the successful treatment of achalasia. Barium swallow, upper endoscopy and high-resolution manometry provide the necessary information...
A precise diagnosis is key to the successful treatment of achalasia. Barium swallow, upper endoscopy and high-resolution manometry provide the necessary information about a patient's anatomy, absence of other diseases, and type of achalasia (I, II, III). High-resolution manometry also has prognostic value, the best results of treatment being obtained in type II achalasia according to the Chicago classification. Abdominal CT scanning and endoscopic ultrasound might be warranted if an underlying malignancy is suspected.
Topics: Esophageal Achalasia; Humans; Manometry; Tomography, X-Ray Computed
PubMed: 35195753
DOI: 10.1007/s00268-022-06483-3 -
International Journal of Molecular... Jun 2017The best-defined primary esophageal motor disorder is achalasia. However, symptoms such as dysphagia, regurgitation and chest pain can be caused by other esophageal... (Review)
Review
The best-defined primary esophageal motor disorder is achalasia. However, symptoms such as dysphagia, regurgitation and chest pain can be caused by other esophageal motility disorders. The Chicago classification introduced new manometric parameters and better defined esophageal motility disorders. Motility disorders beyond achalasia with the current classification are: esophagogastric junction outflow obstruction, major disorders of peristalsis (distal esophageal spasm, hypercontractile esophagus, absent contractility) and minor disorders of peristalsis (ineffective esophageal motility, fragmented peristalsis). The aim of this study was to review the current diagnosis and management of esophageal motility disorders other than achalasia.
Topics: Animals; Esophageal Achalasia; Esophageal Motility Disorders; Esophagus; Humans; Manometry; Peristalsis
PubMed: 28665309
DOI: 10.3390/ijms18071399 -
Chirurgia (Bucharest, Romania : 1990) Feb 2022Achalasia is a condition that can be treated either by surgery, such as Heller myotomy associated with an antireflux procedure, or by pneumatic dilation, the choice of...
Achalasia is a condition that can be treated either by surgery, such as Heller myotomy associated with an antireflux procedure, or by pneumatic dilation, the choice of type of treatment being a widely debated topic nowadays. We selected patients with the diagnosis of achalasia, calculating the Eckardt score on admission and they were treated by pneumatic dilation, respectively by myotomy associated with fundoplication. Therapeutic success at the end of treatment was analyzed, as well as that in subsequent follow-ups. At the same time, other important aspects of the study were quality of life and complications. Forty-eight patients were included, 20 in the group of those treated by pneumatic dilation, and 28 treated by surgery. The results of the therapeutic success were to the advantage of the surgery, both after the completion of the treatment, and in the follow-ups from one year to 2 years (96.4% vs 90%, respectively 92.9% vs. 85%). The quality of life was better in patients with pneumatic dilation throughout the period. Surgical treatment of achalasia has a higher success rate than pneumatic dilation, but the latter is associated with a better quality of life.
Topics: Dilatation; Esophageal Achalasia; Fundoplication; Humans; Quality of Life; Treatment Outcome
PubMed: 35272750
DOI: 10.21614/chirurgia.2683 -
Orphanet Journal of Rare Diseases Jul 2015Idiopathic achalasia is a primary esophageal motor disorder characterized by loss of esophageal peristalsis and insufficient lower esophageal sphincter relaxation in... (Review)
Review
Idiopathic achalasia is a primary esophageal motor disorder characterized by loss of esophageal peristalsis and insufficient lower esophageal sphincter relaxation in response to deglutition. Patients with achalasia commonly complain of dysphagia to solids and liquids, bland regurgitation often unresponsive to an adequate trial of proton pump inhibitor, and chest pain. Weight loss is present in many, but not all patients. Although the precise etiology is unknown, it is often thought to be either autoimmune, viral immune, or neurodegenerative. The diagnosis is based on history of the disease, barium esophagogram, and esophageal motility testing. Endoscopic assessment of the gastroesophageal junction and gastric cardia is necessary to rule out malignancy. Newer diagnostic modalities such as high resolution manometry help in predicting treatment response in achalasia based on esophageal pressure topography patterns identifying three phenotypes of achalasia (I-III) and outcome studies suggest better treatment response with types I and II compared to type III. Although achalasia cannot be permanently cured, excellent outcomes are achieved in over 90 % of patients. Current medical and surgical therapeutic options (pneumatic dilation, endoscopic and surgical myotomy, and pharmacologic agents) aim at reducing the LES pressure and facilitating esophageal emptying by gravity and hydrostatic pressure of retained food and liquids. Either graded pneumatic dilatation or laparoscopic surgical myotomy with a partial fundoplication are recommended as initial therapy guided by patient age, gender, preference, and local institutional expertise. The prognosis in achalasia patients is excellent. Most patients who are appropriately treated have a normal life expectancy but the disease does recur and the patient may need intermittent treatment.
Topics: Barium; Esophageal Achalasia; Esophagoscopy; Esophagus; Gastroesophageal Reflux; Humans; Radiography
PubMed: 26198208
DOI: 10.1186/s13023-015-0302-1 -
The Korean Journal of Internal Medicine Nov 2019Achalasia was first described in the 17th century and its treatment continues to be challenging. Palliative treatment involves disruption of the lower esophageal... (Review)
Review
Achalasia was first described in the 17th century and its treatment continues to be challenging. Palliative treatment involves disruption of the lower esophageal sphincter, which can be accomplished mechanically (balloon dilation or surgical myotomy) or chemically (Botox). True surgical treatment originated some 100 years ago and remained largely unchanged until the advent of thoracoscopic and then laparoscopic myotomy beginning in the 1980s. Because these procedures provided relatively definitive treatment and were well tolerated by patients, minimal invasive surgery assumed a primary role in the treatment algorithms for achalasia. In 2008, an endoscopic (incision-less) myotomy approach, per-oral endoscopic myotomy, was described. This even less invasive approach has rapidly been adopted in the majority of high-volume achalasia centers. Newer interventions, such as stenting and cell transplant, are under active investigation.
Topics: Acetylcholine Release Inhibitors; Botulinum Toxins, Type A; Cell Transplantation; Deglutition; Diffusion of Innovation; Dilatation; Esophageal Achalasia; Esophagoscopy; Esophagus; Humans; Laparoscopy; Palliative Care; Pyloromyotomy; Recovery of Function; Stents; Treatment Outcome
PubMed: 30866609
DOI: 10.3904/kjim.2018.439 -
Molecular Medicine Reports Mar 2020Achalasia is characterized by impaired swallowing due to lower esophageal sphincter (LES) dysfunction and an increased risk of esophageal carcinoma. Aflatoxin is a known... (Clinical Trial)
Clinical Trial
Achalasia is characterized by impaired swallowing due to lower esophageal sphincter (LES) dysfunction and an increased risk of esophageal carcinoma. Aflatoxin is a known carcinogen. Esophageal retention is relieved by per oral endoscopic myotomy (POEM), which lowers the esophageal cancer risk. The present study determined whether aflatoxin is involved in the pathogenesis of achalasia or esophageal cancer. A total of 75 patients with achalasia were prospectively enrolled from a tertiary center. Aflatoxin levels in their esophageal contents were measured using ELISA, and esophageal mucosal specimens were immunohistochemically evaluated for Ki67 and p53 expression prior to and 3 months after POEM. The effect of aflatoxin on esophageal contractility was assessed using murine specimens. Aflatoxin was detected in 67 patients before POEM and only 2 patients after POEM. The number of Ki67‑ and p53‑immunopositive cells in the esophageal mucosa significantly decreased after POEM: [Ki67: 27.8% (95% confidence interval (CI), 25.98‑29.70) vs. 20.7% (95% CI, 19.78‑24.03), P=0.04 and p53: 2.14% (95% CI, 1.85‑2.41) vs. 1.45% (95% CI, 1.22‑1.68), P=0.03]. In vitro experiments revealed that 500 ng/ml aflatoxin significantly increased the amplitude (P<0.05) and frequency (P<0.05) of spontaneous LES contractions compared with the control group. These increases were blocked by co‑treatment with atropine sulfate (P<0.05), but not with a nitric oxide synthase inhibitor (P>0.05). Aflatoxin was found in most patients with achalasia and was eliminated following POEM. Reduced Ki67 and p53 expression after POEM indicated a decreased risk of carcinogenesis. Aflatoxin accumulation increased LES contractility via cholinergic signaling. Therefore, aflatoxin may maintain achalasia symptoms and increase esophageal cancer risk.
Topics: Adolescent; Adult; Aflatoxins; Aged; Aged, 80 and over; Animals; Esophageal Achalasia; Esophageal Mucosa; Esophageal Neoplasms; Female; Humans; Male; Mice; Middle Aged; Prospective Studies; Pyloromyotomy; Risk Factors
PubMed: 31922241
DOI: 10.3892/mmr.2020.10914 -
Clinical Medicine (London, England) Mar 2021Dysphagia is a common symptom which can vary in severity and aetiology; at one end, it can be a benign inconvenience, on the other, there can be serious morbidity...
Dysphagia is a common symptom which can vary in severity and aetiology; at one end, it can be a benign inconvenience, on the other, there can be serious morbidity associated with malnutrition. It is crucial to identify those with mucosal and structural disease, including malignancy as a priority first. Reflux disease is commonly a culprit and treating empirically with acid reducing medicines should follow exclusion of organic disease. Other benign conditions (including eosinophilic oesophagitis) should be considered. The clinical assessment of dysphagia begins with a detailed history and a focus on symptom severity as well as the pre-test probability of a given condition. Tests are then directed at assessing function, and should employ both high-resolution manometry and barium studies. For motility disorders, begin by assessing the oesophago-gastric junction for obstruction (eg achalasia), followed by oesophageal body function. The latter is divided into major and minor motility disorders. Treatment is directed according to the dysmotility phenotype and is based upon background fitness, age and appetite to intervention. Invasive treatment for achalasia is aimed at disrupting the lower oesophageal sphincter muscle while that of oesophageal body disorders is directed at reducing hypercontraction, improving peristalsis or reducing symptoms.
Topics: Deglutition Disorders; Esophageal Achalasia; Esophageal Diseases; Gastroesophageal Reflux; Humans; Manometry
PubMed: 33762370
DOI: 10.7861/clinmed.2021-0069 -
Anales de Pediatria Apr 2020
Topics: Child; Esophageal Achalasia; Esophageal Sphincter, Upper; Humans; Male; Radiography
PubMed: 30744952
DOI: 10.1016/j.anpedi.2019.01.007 -
Journal of Ayub Medical College,... 2018
Topics: Aged, 80 and over; Deglutition Disorders; Esophageal Achalasia; Esophageal Motility Disorders; Female; Humans; Scleroderma, Systemic
PubMed: 29504357
DOI: No ID Found