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Diagnosis and Management of Achalasia: Updates of the Last Two Years

Achalasia is a rare neurodegenerative disorder causing dysphagia and is characterized by abnormal esophageal motor function as well as the loss of lower esophageal sphincter (LES) relaxation. The assessment and management of achalasia has significantly progressed in recent years due to the advances...

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Autores principales: Mari, Amir, Abu Baker, Fadi, Pellicano, Rinaldo, Khoury, Tawfik
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8397142/
https://www.ncbi.nlm.nih.gov/pubmed/34441901
http://dx.doi.org/10.3390/jcm10163607
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author Mari, Amir
Abu Baker, Fadi
Pellicano, Rinaldo
Khoury, Tawfik
author_facet Mari, Amir
Abu Baker, Fadi
Pellicano, Rinaldo
Khoury, Tawfik
author_sort Mari, Amir
collection PubMed
description Achalasia is a rare neurodegenerative disorder causing dysphagia and is characterized by abnormal esophageal motor function as well as the loss of lower esophageal sphincter (LES) relaxation. The assessment and management of achalasia has significantly progressed in recent years due to the advances in high-resolution manometry (HRM) technology along with the improvements and innovations of therapeutic endoscopy procedures. The recent evolution of HRM technology with the inclusion of an adjunctive test, fluoroscopy, and EndoFLIP has enabled more precise diagnoses of achalasia to be made and the subgrouping into therapeutically meaningful subtypes. Current management possibilities include endoscopic treatments such as Botulinum toxin injected to the LES and pneumatic balloon dilation. Surgical treatment includes laparoscopic Heller myotomy and esophagectomy. Furthermore, in recent years, per oral endoscopic myotomy (POEM) has established itself as a principal endoscopic therapeutic alternative to the traditional laparoscopic Heller myotomy. The latest randomized trials report that POEM, pneumatic balloon dilatation, and laparoscopic Heller’s myotomy have comparable effectiveness and complications rates. The aim of the current review is to provide a practical clinical approach to dysphagia and to shed light on the most recent improvements in diagnostics and treatment of achalasia over the last two years.
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spelling pubmed-83971422021-08-28 Diagnosis and Management of Achalasia: Updates of the Last Two Years Mari, Amir Abu Baker, Fadi Pellicano, Rinaldo Khoury, Tawfik J Clin Med Review Achalasia is a rare neurodegenerative disorder causing dysphagia and is characterized by abnormal esophageal motor function as well as the loss of lower esophageal sphincter (LES) relaxation. The assessment and management of achalasia has significantly progressed in recent years due to the advances in high-resolution manometry (HRM) technology along with the improvements and innovations of therapeutic endoscopy procedures. The recent evolution of HRM technology with the inclusion of an adjunctive test, fluoroscopy, and EndoFLIP has enabled more precise diagnoses of achalasia to be made and the subgrouping into therapeutically meaningful subtypes. Current management possibilities include endoscopic treatments such as Botulinum toxin injected to the LES and pneumatic balloon dilation. Surgical treatment includes laparoscopic Heller myotomy and esophagectomy. Furthermore, in recent years, per oral endoscopic myotomy (POEM) has established itself as a principal endoscopic therapeutic alternative to the traditional laparoscopic Heller myotomy. The latest randomized trials report that POEM, pneumatic balloon dilatation, and laparoscopic Heller’s myotomy have comparable effectiveness and complications rates. The aim of the current review is to provide a practical clinical approach to dysphagia and to shed light on the most recent improvements in diagnostics and treatment of achalasia over the last two years. MDPI 2021-08-16 /pmc/articles/PMC8397142/ /pubmed/34441901 http://dx.doi.org/10.3390/jcm10163607 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
Mari, Amir
Abu Baker, Fadi
Pellicano, Rinaldo
Khoury, Tawfik
Diagnosis and Management of Achalasia: Updates of the Last Two Years
title Diagnosis and Management of Achalasia: Updates of the Last Two Years
title_full Diagnosis and Management of Achalasia: Updates of the Last Two Years
title_fullStr Diagnosis and Management of Achalasia: Updates of the Last Two Years
title_full_unstemmed Diagnosis and Management of Achalasia: Updates of the Last Two Years
title_short Diagnosis and Management of Achalasia: Updates of the Last Two Years
title_sort diagnosis and management of achalasia: updates of the last two years
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8397142/
https://www.ncbi.nlm.nih.gov/pubmed/34441901
http://dx.doi.org/10.3390/jcm10163607
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