Achalasia: what is the best treatment?

نویسنده

  • Adamu Ahmed
چکیده

BACKGROUND Achalasia is an infrequent primary motility disorder of the esophagus. Because of uncertain etiology, treatment is only palliative and is directed at decreasing lower esophageal sphincter pressure, improving esophageal emptying and relieving the symptoms of achalasia. Current treatment options include pharmacological, endoscopic and surgical. We undertook a systematic literature review of the management strategies currently available for achalasia. METHOD A Medline, PubMed and Cochrane database search was conducted using reference manager 11. Original articles and reviews published in the English literature on the management of achalasia were reviewed. Emphasis was placed on articles published in the last ten years on randomized controlled trials comparing the various forms of treatment. RESULTS Esophageal manometry is the standard diagnostic evaluation for achalasia. Accurate diagnosis can also be made based on clinical findings and barium esophagogram. Medical treatment with nitrates or calcium channel blockers has variable results in alleviating the symptoms of achalasia but long-term results are disappointing because of tolerance and side effects. Intrasphincteric injection of botulinum toxin, pneumatic dilatation and surgical myotomy are variably effective at controlling the symptoms of achalasia but each modality has specific strength and weaknesses which make their choice suitable in a particular group of patients. While pneumatic dilatation is superior to botulinum toxin injection surgical myotomy provides the best long-term control of symptoms in patients with achalasia. CONCLUSION Laparoscopic myotomy should be the initial treatment for most patients with achalasia. Pneumatic dilatation is the most cost-effective alternative but its long-term efficacy is less than that of surgical myotomy. Endoscopic botulinum toxin injection can be considered when other forms of treatment are contraindicated.

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

منابع مشابه

Surgical Treatment for Achalasia of the Esophagus: Laparoscopic Heller Myotomy

Achalasia is an esophageal motility disorder that leads to dysphagia, chest pain, and weight loss. Its diagnosis is clinically suspected and is confirmed with esophageal manometry. Although pneumatic dilation has a role in the treatment of patients with achalasia, laparoscopic Heller myotomy is considered by many experts as the best treatment modality for most patients with newly diagnosed acha...

متن کامل

Achalasia: an overview of diagnosis and treatment.

Achalasia is a primary esophageal disorder involving the body of the esophagus and lower esophageal sphincter affecting equally both genders and all ages. While its etiology remains unclear, the pathophysiologic mechanism involves the destruction of the myenteric plexi responsible for esophageal peristalsis. Given the slow, initially oligosymptomatic progression and relative low prevalence of d...

متن کامل

INJECTION OF BOTULINUM TOXIN IN THE TREATMENT OF ACHALASIA: A RANDOMIZED, DOUBLE BLIND, CONTROLLED CLINICAL TRIAL

Our aim was to evaluate the short and long term efficacy of botulinum toxin therapy in Iranian patients with achalasia. In a randomized, double blind trial, 20 patients with achalasia, referring to Imam Khomeini Hospital, received either 80 units of botulinum toxin (BT) or placebo (PL) from 1995 to 1998. Two weeks later, the response to treatment was assessed on the basis of changes in the...

متن کامل

Surgical treatment of achalasia: current status and controversies.

OBJECTIVE To review the current management of achalasia, and the controversies regarding the different treatment options. METHODS A review of the literature was performed. The key words used were esophageal achalasia, Heller myotomy, endoscopic balloon dilatation, laparoscopic Heller myotomy, and fundoplication. RESULTS Patients who fail medical therapy (e.g. pharmacologic therapy, botulinu...

متن کامل

Achalasia Cardia Subtyping by High-Resolution Manometry Predicts the Therapeutic Outcome of Pneumatic Balloon Dilatation

BACKGROUND/AIMS High-resolution manometry (HRM) with pressure topography is used to subtype achalasia cardia, which has therapeutic implications. The aim of this study was to compare the clinical characteristics, manometric variables and treatment outcomes among the achalasia subtypes based on the HRM findings. METHODS The patients who underwent HRM at the Asian Institute of Gastroenterology,...

متن کامل

ذخیره در منابع من


  با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

عنوان ژورنال:
  • Annals of African medicine

دوره 7 3  شماره 

صفحات  -

تاریخ انتشار 2008