Achalasia is a rare motility disorder with incomplete relaxation of the lower esophageal sphincter and ineffective contractions of the esophageal body. It has been hypothesized that achalasia does not result from only one pathway but rather involves a combination of infectious, autoimmune, and familial etiological components. On the basis of other observations, a novel hypothesis suggests that a muscular form of eosinophilic esophagitis is involved in the pathophysiology of achalasia in some patients. This appears to progressively diminish the myenteric plexus at stage III, gradually destroy it at stage II, and finally eliminate it at stage I, the most advanced and final stage of achalasia. Although high-resolution manometry has identified these three different types of achalasia, another subset of patients with a normal-appearing sphincter relaxation has been proposed. Provocative maneuvers, such as the rapid drinking challenge, have recently been demonstrated to improve diagnosis in certain borderline patients, but have to be studied in more detail. However, whether the different types of achalasia will have a long-term impact on tailored therapies is still a matter of debate. Additionally, novel aspects of the standard timed barium swallow appear to be an important adjunct of diagnosis, as it has been shown to have a diagnostic as well as a predictive value.
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Pre- and post-intervention oesophageal pressure topography metrics in the three subtypes of achalasia: A pilot study on Indian adults.
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Background: Achalasia is characterized by failure of relaxation of the lower oesophageal sphincter (LOS) and abnormal peristalsis during swallowing. The study aimed to observe the effects of intervention in three sub-types of achalasia and compare the intervention outcomes among the three sub-types.
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Delta-integrated relaxation pressures as a new high-resolution manometry metric to predict the positive outcome of laparoscopic Heller-Dor in patients with achalasia.
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Unit of General Surgery 1, Department of Surgery, Oncology, and Gastroenterology, School of Medicine, University of Padova, Padova, Italy. Electronic address:
Background: There is no consensus on the definition of failure after treatment in patients with achalasia. The Eckardt score is used to define clinical outcomes. However, objective metrics are lacking.
View Article and Find Full Text PDFUpper Esophageal Sphincter Abnormalities and Esophageal Motility Recovery After Peroral Endoscopic Myotomy for Achalasia.
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Department of Gastroenterology and Hepatology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Xuhui District, Shanghai, 200032, China.
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- A study investigated abnormalities in the upper esophageal sphincter (UES) in achalasia patients and the effects of peroral endoscopic myotomy (POEM) on the UES and esophageal body, revealing that 65.6% of participants had UES issues before treatment.
- Pre-treatment scores indicated greater difficulty swallowing and symptom severity in patients with UES abnormalities compared to those with normal UES functionality.
- Post-POEM results demonstrated a significant reduction in UES pressure and improved peristalsis in type II and III achalasia patients, although type I patients showed no contractility after the procedure.
Treatment outcomes and esophageal cancer incidence by disease type in achalasia patients undergoing peroral endoscopic myotomy: Retrospective study.
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Department of Gastroenterological Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan.
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- - The study analyzed the outcomes of peroral endoscopic myotomy (POEM) in 450 achalasia patients, classifying the disease into straight and sigmoid types, to assess treatment effectiveness and the risk of developing esophageal cancer (EC).
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Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue/Desk J4-133, Cleveland, OH, 44915, USA.
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