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

Journal of Clinical Medicine

Halim Awadie¹  Wisam Abboud²  Tawfik Khoury²  Wisam Sbeit²  Amir Mari³ 

[1] Emek Medical Center, Institute of Gastroenterology and Hepatology, Afula 1855701, Israel;Faculty of Medicine, Bar-Ilan University, Safed 5290002, Israel;Gastroenterology and Endoscopy United, The Nazareth Hospital, EMMS, Nazareth 1613101, Israel;

关键词: achalasia;    elderly;    approach;    POEM;    myotomy;   

DOI  :  10.3390/jcm10235565

来源: DOAJ

【 摘 要 】

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.

【 授权许可】

Unknown