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Idiopathic (primary) achalasia: a review.

Patel DA, Kim HP, Zifodya JS, Vaezi MF - Orphanet J Rare Dis (2015)

Bottom Line: 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.Most patients who are appropriately treated have a normal life expectancy but the disease does recur and the patient may need intermittent treatment.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Nashville, TN, USA.

ABSTRACT
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.

No MeSH data available.


Related in: MedlinePlus

Timed barium swallow before and after pneumatic dilation showing retention of barium in the former and complete emptying post effective therapy in the latter
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Fig4: Timed barium swallow before and after pneumatic dilation showing retention of barium in the former and complete emptying post effective therapy in the latter

Mentions: In 1997 de Oliveira et al. [68] described timed barium esophagogram as a simple, noninvasive, and widely available barium technique for evaluating esophageal emptying in patients with achalasia, which can provide objective assessment after therapy as in many patients with achalasia, symptom relief does not always parallel esophageal emptying. The films in this technique are taken at 1, 2 and 5 minutes after the last swallow of barium; the purpose of 2 min film is to assess interim emptying (Fig. 4). The technique is simple to interpret because both radiologists and gastroenterologists can accurately assess emptying. Emptying can be assessed by the height time width of the barium column or a qualitative estimate of emptying. This method can be also used in predicting the success of treatment in patients with achalasia, which will be discussed later [68–71].Fig. 4


Idiopathic (primary) achalasia: a review.

Patel DA, Kim HP, Zifodya JS, Vaezi MF - Orphanet J Rare Dis (2015)

Timed barium swallow before and after pneumatic dilation showing retention of barium in the former and complete emptying post effective therapy in the latter
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4509143&req=5

Fig4: Timed barium swallow before and after pneumatic dilation showing retention of barium in the former and complete emptying post effective therapy in the latter
Mentions: In 1997 de Oliveira et al. [68] described timed barium esophagogram as a simple, noninvasive, and widely available barium technique for evaluating esophageal emptying in patients with achalasia, which can provide objective assessment after therapy as in many patients with achalasia, symptom relief does not always parallel esophageal emptying. The films in this technique are taken at 1, 2 and 5 minutes after the last swallow of barium; the purpose of 2 min film is to assess interim emptying (Fig. 4). The technique is simple to interpret because both radiologists and gastroenterologists can accurately assess emptying. Emptying can be assessed by the height time width of the barium column or a qualitative estimate of emptying. This method can be also used in predicting the success of treatment in patients with achalasia, which will be discussed later [68–71].Fig. 4

Bottom Line: 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.Most patients who are appropriately treated have a normal life expectancy but the disease does recur and the patient may need intermittent treatment.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Nashville, TN, USA.

ABSTRACT
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.

No MeSH data available.


Related in: MedlinePlus