Achalasia
Top Cited Papers
- 12 May 2015
- journal article
- review article
- Published by American Medical Association (AMA) in Jama-Journal Of The American Medical Association
- Vol. 313 (18), 1841-1852
- https://doi.org/10.1001/jama.2015.2996
Abstract
Importance Achalasia significantly affects patients’ quality of life and can be difficult to diagnose and treat. Objective To review the diagnosis and management of achalasia, with a focus on phenotypic classification pertinent to therapeutic outcomes. Evidence Review Literature review and MEDLINE search of articles from January 2004 to February 2015. A total of 93 articles were included in the final literature review addressing facets of achalasia epidemiology, pathophysiology, diagnosis, treatment, and outcomes. Nine randomized controlled trials focusing on endoscopic or surgical therapy for achalasia were included (734 total patients). Findings A diagnosis of achalasia should be considered when patients present with dysphagia, chest pain, and refractory reflux symptoms after an endoscopy does not reveal a mechanical obstruction or an inflammatory cause of esophageal symptoms. Manometry should be performed if achalasia is suspected. Randomized controlled trials support treatments focused on disrupting the lower esophageal sphincter with pneumatic dilation (70%-90% effective) or laparoscopic myotomy (88%-95% effective). Patients with achalasia have a variable prognosis after endoscopic or surgical myotomy based on subtypes, with type II (absent peristalsis with abnormal pan-esophageal high-pressure patterns) having a very favorable outcome (96%) and type I (absent peristalsis without abnormal pressure) having an intermediate prognosis (81%) that is inversely associated with the degree of esophageal dilatation. In contrast, type III (absent peristalsis with distal esophageal spastic contractions) is a spastic variant with less favorable outcomes (66%) after treatment of the lower esophageal sphincter. Conclusions and Relevance Achalasia should be considered when dysphagia is present and not explained by an obstruction or inflammatory process. Responses to treatment vary based on which achalasia subtype is present.This publication has 74 references indexed in Scilit:
- Longitudinal Muscle Dysfunction in Achalasia Esophagus and Its RelevanceJournal of Neurogastroenterology and Motility, 2013
- Origin and modulation of circular smooth muscle layer contractions in the porcine esophagusNeurogastroenterology & Motility, 2012
- An Epidemiological Study of Achalasia Among the South Asian Population of Leicester, 1986–2005Dysphagia, 2007
- Achalasia in Iceland, 1952–2002: An Epidemiologic StudyDigestive Diseases and Sciences, 2007
- Enteric co-innervation of motor endplates in the esophagus: state of the art ten years afterHistochemistry and Cell Biology, 2005
- Regional differences in the response of feline esophageal smooth muscle to stretch and cholinergic stimulationAmerican Journal of Physiology-Gastrointestinal and Liver Physiology, 2001
- Modulation of feline esophageal contractions by bolus volume and outflow obstructionAmerican Journal of Physiology-Gastrointestinal and Liver Physiology, 1990
- Responses of the human esophagus to paired swallowsGastroenterology, 1987
- Regional gradient of initial inhibition and refractoriness in esophageal smooth muscleGastroenterology, 1985
- Effect of time interval between swallows on esophageal peristalsisAmerican Journal of Physiology-Gastrointestinal and Liver Physiology, 1980