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The Pathogenesis and Management of Achalasia: Current Status and Future Directions.

Ates F, Vaezi MF - Gut Liver (2015)

Bottom Line: Pneumatic dilation and surgical myotomy are the only definitive treatment options for patients with achalasia who can undergo surgery.Botulinum toxin injection into the lower esophageal sphincter should be reserved for those who cannot undergo definitive therapy.Close follow-up is paramount because many patients will have a recurrence of symptoms and require repeat treatment.

View Article: PubMed Central - PubMed

Affiliation: Division of Gastroenterology, Hepatology, and Nutrition, Center for Swallowing and Esophageal Disorders, Vanderbilt University Medical Center, Nashville, TN, USA.

ABSTRACT
Achalasia is an esophageal motility disorder that is commonly misdiagnosed initially as gastroesophageal reflux disease. Patients with achalasia often complain of dysphagia with solids and liquids but may focus on regurgitation as the primary symptom, leading to initial misdiagnosis. Diagnostic tests for achalasia include esophageal motility testing, esophagogastroduodenoscopy and barium swallow. These tests play a complimentary role in establishing the diagnosis of suspected achalasia. High-resolution manometry has now identified three subtypes of achalasia, with therapeutic implications. Pneumatic dilation and surgical myotomy are the only definitive treatment options for patients with achalasia who can undergo surgery. Botulinum toxin injection into the lower esophageal sphincter should be reserved for those who cannot undergo definitive therapy. Close follow-up is paramount because many patients will have a recurrence of symptoms and require repeat treatment.

No MeSH data available.


Related in: MedlinePlus

Manometric tracings of achalasia by conventional water-perfused manometry: (A) simultaneous esophageal contractions associated with high lower esophageal sphincter (LES) pressure and (B) incomplete relaxation. High-resolution manometry tracings of (C) normal esophageal peristalsis and (D) achalasia showing simultaneous contractions along the esophagus with high E-sleeve LES pressure and incomplete relaxation. EGJ, esophagogastric junction; UES, upper esophageal sphincter.
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f4-gnl-09-449: Manometric tracings of achalasia by conventional water-perfused manometry: (A) simultaneous esophageal contractions associated with high lower esophageal sphincter (LES) pressure and (B) incomplete relaxation. High-resolution manometry tracings of (C) normal esophageal peristalsis and (D) achalasia showing simultaneous contractions along the esophagus with high E-sleeve LES pressure and incomplete relaxation. EGJ, esophagogastric junction; UES, upper esophageal sphincter.

Mentions: The manometric finding of aperistalsis and incomplete LES relaxation without evidence of a mechanical obstruction solidifies the diagnosis of achalasia in the appropriate setting (Table 1, Fig. 4).80 Other findings, such as an increased basal LES pressure, an elevated baseline esophageal body pressure, and simultaneous nonpropagating contractions, may also support the diagnosis of achalasia, but these are not requirements for the diagnosis.7


The Pathogenesis and Management of Achalasia: Current Status and Future Directions.

Ates F, Vaezi MF - Gut Liver (2015)

Manometric tracings of achalasia by conventional water-perfused manometry: (A) simultaneous esophageal contractions associated with high lower esophageal sphincter (LES) pressure and (B) incomplete relaxation. High-resolution manometry tracings of (C) normal esophageal peristalsis and (D) achalasia showing simultaneous contractions along the esophagus with high E-sleeve LES pressure and incomplete relaxation. EGJ, esophagogastric junction; UES, upper esophageal sphincter.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4477988&req=5

f4-gnl-09-449: Manometric tracings of achalasia by conventional water-perfused manometry: (A) simultaneous esophageal contractions associated with high lower esophageal sphincter (LES) pressure and (B) incomplete relaxation. High-resolution manometry tracings of (C) normal esophageal peristalsis and (D) achalasia showing simultaneous contractions along the esophagus with high E-sleeve LES pressure and incomplete relaxation. EGJ, esophagogastric junction; UES, upper esophageal sphincter.
Mentions: The manometric finding of aperistalsis and incomplete LES relaxation without evidence of a mechanical obstruction solidifies the diagnosis of achalasia in the appropriate setting (Table 1, Fig. 4).80 Other findings, such as an increased basal LES pressure, an elevated baseline esophageal body pressure, and simultaneous nonpropagating contractions, may also support the diagnosis of achalasia, but these are not requirements for the diagnosis.7

Bottom Line: Pneumatic dilation and surgical myotomy are the only definitive treatment options for patients with achalasia who can undergo surgery.Botulinum toxin injection into the lower esophageal sphincter should be reserved for those who cannot undergo definitive therapy.Close follow-up is paramount because many patients will have a recurrence of symptoms and require repeat treatment.

View Article: PubMed Central - PubMed

Affiliation: Division of Gastroenterology, Hepatology, and Nutrition, Center for Swallowing and Esophageal Disorders, Vanderbilt University Medical Center, Nashville, TN, USA.

ABSTRACT
Achalasia is an esophageal motility disorder that is commonly misdiagnosed initially as gastroesophageal reflux disease. Patients with achalasia often complain of dysphagia with solids and liquids but may focus on regurgitation as the primary symptom, leading to initial misdiagnosis. Diagnostic tests for achalasia include esophageal motility testing, esophagogastroduodenoscopy and barium swallow. These tests play a complimentary role in establishing the diagnosis of suspected achalasia. High-resolution manometry has now identified three subtypes of achalasia, with therapeutic implications. Pneumatic dilation and surgical myotomy are the only definitive treatment options for patients with achalasia who can undergo surgery. Botulinum toxin injection into the lower esophageal sphincter should be reserved for those who cannot undergo definitive therapy. Close follow-up is paramount because many patients will have a recurrence of symptoms and require repeat treatment.

No MeSH data available.


Related in: MedlinePlus