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

Journal of Clinical Medicine

Amir Mari¹  Tawfik Khoury²  Rinaldo Pellicano³  Fadi Abu Baker⁴ 

[1] Department of Gastroenterology, Nazareth Hospital, Faculty of Medicine, Bar-Ilan University, Safed 16100, Israel;Galilee Medical Center, Department of Gastroenterology, Faculty of Medicine in the Galilee, Bar-Ilan University, Safed 13100, Israel;Gastroenterology Unit, Molinette Hospital, 10126 Turin, Italy;Hillel Yaffe Medical Center, Department of Gastroenterology and Hepatology, Hadera 38100, Israel;

关键词: dysphagia;    achalasia;    diagnosis;    high resolution manometry (HRM);    management;    per oral endoscopic myotomy (POEM);   

DOI  :  10.3390/jcm10163607

来源: DOAJ

【 摘 要 】

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.

【 授权许可】

Unknown