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Query: UMLS:C0014848 (achalasia)
 2,804 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Achalasia cannot be cured. Instead, our goal is to relieve symptoms of dysphagia and regurgitation, improve esophageal emptying and prevent the development of megaesophagus. The most definitive therapies are pneumatic dilation and surgical myotomy. The overall success of grade pneumatic dilation is 78%, with women and older patients performing best. Laparoscopic myotomy has an overall success rate of 85%, but can be complicated by the sequelae of severe acid reflux disease. Young patients, especially men, are the best candidates for surgical myotomy. There are no prospective, randomized studies comparing these two procedures. Botulinum toxin injections into the esophagus and smooth muscle relaxants are reserved for older patients or those with major comorbid illnesses. Some patients with end-stage achalasia will require esophagectomy.
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PMID:Update on the management of achalasia: balloons, surgery and drugs. 1907 91

Primary esophageal motility disorders are rare, the most common diagnoses being achalasia and diffuse esophageal spasm. Treatment aims to alleviate symptoms and may be medical, endoscopic, or surgical. Achalasia is most commonly treated by pneumatic dilatation or by laparoscopic Heller cardiomyotomy. Pneumatic dilatation is effective in 60-80% of cases, but functional results deteriorate over time. Surgical treatment is indicated when endoscopic dilatation is contraindicated or has failed. Functional results after cardiomyotomy are satisfactory in 90% of cases and results appear to be stable over time. The need for an associated antireflux procedure and the type of fundoplication remain controversial. For diffuse esophageal spasm, extended esophageal myotomy has yielded satisfactory functional results, but surgical treatment should be reserved for selected patients with severe symptoms.
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PMID:[Surgical management of primary esophageal motility disorders]. 1910 62

Achalasia is an infrequent esophageal disease that severely impairs the quality of life of affected individuals. The etiology of this entity is not well defined and its main clinical features are dysphagia and regurgitation. The treatment of achalasia continues to be palliative and is aimed at providing functional and symptomatic relief through opening of the lower esophageal sphincter. The present article describes and evaluates the medical and surgical treatments most commonly used in clinical practice after the introduction of minimally invasive surgery, which has represented an important addition to the therapeutic alternatives. Currently, the most appropriate initial option is laparoscopic surgery, while pneumatic dilatation and botulinum toxin injection should be reserved for selected patients.
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PMID:[Surgical treatment of achalasia: Better than dilations?]. 1963 12

Achalasia is an esophageal motility disorder of unknown cause, characterized by aperistalsis of the esophageal body and impaired lower esophageal sphincter relaxation. Patients present at all ages, primarily with dysphagia for solids/liquids and bland regurgitation. The diagnosis is suggested by barium esophagram and confirmed by esophageal manometry. Achalasia cannot be cured. Instead, our goal is to relieve symptoms, improve esophageal emptying and prevent the development of megaesophagus. The most successful therapies are pneumatic dilation and surgical myotomy. The overall success rate of graded pneumatic dilation is 78%, with women and older patients responding best. Laparoscopic myotomy, usually combined with a partial fundoplication, has an overall success rate of 87%. Young patients, especially men, are the best candidates for surgical myotomy. Botulinum toxin injection into the lower esophageal sphincter and smooth muscle relaxants are usually reserved for older patients or those with co-morbid illness. The prognosis for achalasia patients to return to near normal swallowing is good, but the disease is rarely "cured" with a single procedure and intermittent touch-up procedures may be required.
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PMID:Achalasia - an update. 2068 Jan 61

Achalasia is a primary esophageal motility disorder characterized by aperistalsis and incomplete or absent relaxation of the lower esophageal sphincter (LES). The cause of the disease remains elusive and there is no intervention that improves the esophageal body function. Currently, treatment options focus on palliation of symptoms by reducing the LES pressure. The most effective and well-tolerated treatments continue to be the laparoscopic Heller myotomy and endoscopic pneumatic dilation; however, newer techniques (eg, peroral endoscopic myotomy and self-expanding metal stents) show promise. Botulinum toxin and pharmacologic therapy are reserved for those who are unable to undergo more effective therapies. Treatment options should be tailored to the patient, using current predictors of outcome such as the patient's age and post-treatment LES pressures. The aim of this article is to highlight current literature and provide an up-to-date approach to the treatment of achalasia.
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PMID:Current approach to the treatment of achalasia. 2142 34

Controversy exists with regard to the optimal treatment for achalasia and whether surveillance for early recognition of late complications is indicated. Currently, surgical myotomy and pneumatic dilation are the most effective treatments for patients with idiopathic achalasia, and a multicenter, randomized, international trial has confirmed similar efficacy of these treatments, at least in the short term. Clinical predictors of outcome, patient preferences and local expertise should be considered when making a decision on the most appropriate treatment option. Owing to a lack of long-term benefit, endoscopic botulinum toxin injection and medical therapies are reserved for patients of advanced age and those with clinically significant comorbidites. The value of new endoscopic, radiologic or surgical treatments, such as peroral endoscopic myotomy, esophageal stenting and robotic-assisted myotomy has not been fully established. Finally, long-term follow-up data in patients with achalasia support the notion that surveillance strategies might be beneficial after a disease duration of more than 10-15 years.
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PMID:Treatment and surveillance strategies in achalasia: an update. 2152 16

Achalasia is a rare motor disorder of the esophagus, characterized by the absence of peristalsis and impaired swallow-induced relaxation. In the past decade, evidence has been accumulated suggesting that achalasia may be an immune-mediated inflammatory disorder. With the advent of minimally invasive surgery, laparoscopic Heller myotomy (LHM) has slowly shifted the treatment of achalasia toward the greater use of surgical therapy. The goal of both surgical and nonsurgical treatment is to eliminate the outflow obstruction afforded by a nonrelaxing sphincter, relieving dysphagia and maintaining a barrier against gastroesophageal reflux (GER). Endoscopic botulinum toxin injection (EBTI) is safe, easy to perform, inexpensive, and effective in aged patients, and it is especially effective when the lower esophageal pressure is hypertonic. This therapeutic option is reserved for patients too ill to undergo any surgical procedure. Pneumatic dilation (PD) has been shown to be an effective and inexpensive treatment with few adverse effects. The long-term success rate of PD seems to drop progressively over time. Heller myotomy (HM) has shown the best clinical efficacy in achalasia as a first-line treatment. Multiple endoscopic treatments are associated with poorer outcomes after HM. EBTI also makes LHM more difficult and results in a worse surgical outcome. The inferior symptomatic outcomes after thoracoscopic HM may be caused by the difficulty in extending an adequate myotomy onto the stomach from the chest and the inability to create a fundoplication. LHM with Dor's fundoplication (LHM + Dor) is effective and is safer procedure for avoiding GER, dysphagia, mucosal perforation, and a pseudodiverticulum. LHM + Dor is also effective in the presence of sigmoid achalasia, but the clinical result is not as good as nonsigmoid achalasia. A few patients need esophagectomy for surgical failure of HM. However, considering the risk of esophagectomy, LHM + Dor is the first treatment option for patients with achalasia regardless of the degree of esophageal dilatation. This procedure is therefore considered to be an effective and safe treatment for patients of any age or with any condition.
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PMID:Surgical treatment for achalasia: when should it be performed, and for which patients? 2167 5

Achalasia is an esophageal motility disorder for which the pathophysiology is only partially known for the idiopathic subtype. Many factors are known to be involved with the development of secondary achalasia. Neurofibromatosis is one of the most common autosomal dominant conditions affecting the nervous system, and 25% of those with the disease have been reported to have involvement of the gastrointestinal tract. Three cases of association between neurofibromatosis and achalasia have been reported in the literature so far. Laparoscopic Heller myotomy is the gold standard surgical treatment for patients with achalasia, whereas esophagectomy is reserved for the more advanced stages of disease. There have been reports of successful long-term results in patients with stage IV achalasia treated with Heller myotomy. We report the fourth case in the literature of association between achalasia and neurofibromatosis; it is the first time that such an association is successfully treated with laparoscopic Heller myotomy.
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PMID:End-stage achalasia in a patient with neurofibromatosis treated with laparoscopic Heller myotomy. 2200 92

Pneumatic dilation of achalasia has a same medium-term efficacy than surgery and is commonly proposed as the first-line treatment. Intra-sphincteric injection of botulinum toxin is reserved for elderly patients with serious comorbidities. Per-endoscopic myotomy is possible but needs to be evaluated by further studies. Laparoscopic Heller's myotomy in first intension is reserved for young patients less than 40 years. Results of Heller's myotomy are not modified by prior endoscopic treatment or by mega-esophagus. Better surgery results are shown in recent and severe achalasia.
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PMID:[Achalasia: role of endoscopic therapy and surgery]. 2295 37

Endoscopic therapy for achalasia is directed at disrupting or weakening the lower esophageal sphincter (LES). The two most commonly utilized endoscopic interventions are large balloon pneumatic dilation (PD) and botulinum toxin injection (BTI). These interventions have been extensively scrutinized and compared with each other as well as with surgical disruption (myotomy) of the LES. PD is generally more effective in improving dysphagia in achalasia than BTI, with the latter reserved for infirm older people, and PD may approach treatment results attained with myotomy. However, PD may need to be repeated. Small balloon dilation and endoscopic stent placement for achalasia have only been used in select centers. Per oral endoscopic myotomy is a newer endoscopic modality that will likely change the treatment paradigm for achalasia. It arose from the field of natural orifice transluminal endoscopic surgery and represents a scarless endoscopic approach to Heller myotomy. This is a technique that requires extensive training and preparation and thus there should be rigorous accreditation and monitoring of outcomes to ensure safety and efficacy.
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PMID:Endoscopic approaches to treatment of achalasia. 2350 7


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