Cargando…

Achalasia in the Elderly: Diagnostic Approach and a Proposed Treatment Algorithm Based on a Comprehensive Literature Review

Achalasia is not uncommonly diagnosed in elderly patients and its incidence and prevalence are growing in this population. However, a scarcity of studies has assessed the typical pathophysiological and clinical features of the disease as well as the effectiveness and safety of the various therapeuti...

Descripción completa

Detalles Bibliográficos
Autores principales: Mari, Amir, Sbeit, Wisam, Abboud, Wisam, Awadie, Halim, Khoury, Tawfik
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8658648/
https://www.ncbi.nlm.nih.gov/pubmed/34884267
http://dx.doi.org/10.3390/jcm10235565
_version_ 1784612779703926784
author Mari, Amir
Sbeit, Wisam
Abboud, Wisam
Awadie, Halim
Khoury, Tawfik
author_facet Mari, Amir
Sbeit, Wisam
Abboud, Wisam
Awadie, Halim
Khoury, Tawfik
author_sort Mari, Amir
collection PubMed
description Achalasia is not uncommonly diagnosed in elderly patients and its incidence and prevalence are growing in this population. However, a scarcity of studies has assessed the typical pathophysiological and clinical features of the disease as well as the effectiveness and safety of the various therapeutic options in elderly populations. Botulinum toxin injection has been used for achalasia treatment since 1994 and is traditionally considered the preferred treatment for fragile elder patients. However, recently more evidence has become available regarding the safety and effectiveness of pneumatic balloon dilation (BD), laparoscopic Heller myotomy (LHM) and per-oral endoscopic myotomy (POEM) in elderly patients with achalasia. In the current review we present the current literature on this topic with a focus on the clinical presentation of achalasia in the elderly and manometric features thereof, as well as summarize the effectiveness and safety of the various therapeutic options. Furthermore, we propose a practical management algorithm as a means to guide the treatment of future cases. We recommend that a conservative/BTI approach should be adopted in the fragile unfit patient. In the elderly fit patient, the treatment decision should be based on the achalasia type, patient preference and the available expertise, similar to the approach adopted for the non-elderly population.
format Online
Article
Text
id pubmed-8658648
institution National Center for Biotechnology Information
language English
publishDate 2021
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-86586482021-12-10 Achalasia in the Elderly: Diagnostic Approach and a Proposed Treatment Algorithm Based on a Comprehensive Literature Review Mari, Amir Sbeit, Wisam Abboud, Wisam Awadie, Halim Khoury, Tawfik J Clin Med Review Achalasia is not uncommonly diagnosed in elderly patients and its incidence and prevalence are growing in this population. However, a scarcity of studies has assessed the typical pathophysiological and clinical features of the disease as well as the effectiveness and safety of the various therapeutic options in elderly populations. Botulinum toxin injection has been used for achalasia treatment since 1994 and is traditionally considered the preferred treatment for fragile elder patients. However, recently more evidence has become available regarding the safety and effectiveness of pneumatic balloon dilation (BD), laparoscopic Heller myotomy (LHM) and per-oral endoscopic myotomy (POEM) in elderly patients with achalasia. In the current review we present the current literature on this topic with a focus on the clinical presentation of achalasia in the elderly and manometric features thereof, as well as summarize the effectiveness and safety of the various therapeutic options. Furthermore, we propose a practical management algorithm as a means to guide the treatment of future cases. We recommend that a conservative/BTI approach should be adopted in the fragile unfit patient. In the elderly fit patient, the treatment decision should be based on the achalasia type, patient preference and the available expertise, similar to the approach adopted for the non-elderly population. MDPI 2021-11-26 /pmc/articles/PMC8658648/ /pubmed/34884267 http://dx.doi.org/10.3390/jcm10235565 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
Sbeit, Wisam
Abboud, Wisam
Awadie, Halim
Khoury, Tawfik
Achalasia in the Elderly: Diagnostic Approach and a Proposed Treatment Algorithm Based on a Comprehensive Literature Review
title Achalasia in the Elderly: Diagnostic Approach and a Proposed Treatment Algorithm Based on a Comprehensive Literature Review
title_full Achalasia in the Elderly: Diagnostic Approach and a Proposed Treatment Algorithm Based on a Comprehensive Literature Review
title_fullStr Achalasia in the Elderly: Diagnostic Approach and a Proposed Treatment Algorithm Based on a Comprehensive Literature Review
title_full_unstemmed Achalasia in the Elderly: Diagnostic Approach and a Proposed Treatment Algorithm Based on a Comprehensive Literature Review
title_short Achalasia in the Elderly: Diagnostic Approach and a Proposed Treatment Algorithm Based on a Comprehensive Literature Review
title_sort achalasia in the elderly: diagnostic approach and a proposed treatment algorithm based on a comprehensive literature review
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8658648/
https://www.ncbi.nlm.nih.gov/pubmed/34884267
http://dx.doi.org/10.3390/jcm10235565
work_keys_str_mv AT mariamir achalasiaintheelderlydiagnosticapproachandaproposedtreatmentalgorithmbasedonacomprehensiveliteraturereview
AT sbeitwisam achalasiaintheelderlydiagnosticapproachandaproposedtreatmentalgorithmbasedonacomprehensiveliteraturereview
AT abboudwisam achalasiaintheelderlydiagnosticapproachandaproposedtreatmentalgorithmbasedonacomprehensiveliteraturereview
AT awadiehalim achalasiaintheelderlydiagnosticapproachandaproposedtreatmentalgorithmbasedonacomprehensiveliteraturereview
AT khourytawfik achalasiaintheelderlydiagnosticapproachandaproposedtreatmentalgorithmbasedonacomprehensiveliteraturereview