Achalasia is an esophageal motility disorder characterized by impaired lower esophageal sphincter relaxation and peristalsis of the esophageal body. With the increasing prevalence of achalasia, interest in the role of endoscopy in its diagnosis, treatment, and monitoring is also growing. The major diagnostic modalities for achalasia include high-resolution manometry, esophagogastroduodenoscopy, and barium esophagography. Endoscopic assessment is important for early diagnosis to rule out diseases that mimic achalasia symptoms, such as pseudo-achalasia, esophageal cancer, esophageal webs, and eosinophilic esophagitis. The major endoscopic characteristics suggestive of achalasia include a widened esophageal lumen and food residue in the esophagus. Once diagnosed, achalasia can be treated either endoscopically or surgically. The preference for endoscopic treatment is increasing owing to its minimal invasiveness. Botulinum toxins, pneumatic balloon dilation, and peroral endoscopic myotomy (POEM) are important endoscopic treatments. Previous studies have demonstrated excellent treatment outcomes for POEM, with >95% improvement in dysphagia, making POEM the mainstay treatment option for achalasia. Several studies have reported an increased risk of esophageal cancer in patients with achalasia. However, routine endoscopic surveillance remains controversial owing to the lack of sufficient data. Further studies on surveillance methods and duration are warranted to establish concordant guidelines for the endoscopic surveillance of achalasia.
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http://dx.doi.org/10.5946/ce.2023.001 | DOI Listing |
Cureus
December 2024
Department of Surgery, Zen Hospital, Mumbai, IND.
Achalasia cardia is a primary motility disorder of the esophagus marked by the absence of peristalsis and the failure of the lower esophageal sphincter (LES) to relax during swallowing. The preferred surgical approach is laparoscopic Heller's cardiomyotomy with Dor's fundoplication. Given the significant risks of mucosal perforation and the possibility of incomplete myotomy, which can lead to symptom recurrence, it is essential to ensure both the completeness of the myotomy and the preservation of the mucosal integrity.
View Article and Find Full Text PDFJ Clin Gastroenterol
February 2025
Digestive Disease and Surgery Institute, Cleveland Clinic London, UK.
Peroral endoscopic myotomy (POEM) is a novel technique within the field of third space endoscopy. The overarching principal is creation of a mucosal incision, careful dissection of the submucosal space using an electrosurgical knife to reach the muscularis (ie, tunneling), performing a controlled myotomy, and finally, closure of the mucosal incision. POEM was first developed for the management of achalasia, and now a decade of evidence shows the procedure is safe, effective, and highly reproducible.
View Article and Find Full Text PDFACG Case Rep J
January 2025
Departamento de Gastroenterología, Clínica Reina Sofía, Clínica Colsanitas, Grupo Keralty, Bogotá, Colombia.
Achalasia is a rare esophageal motor disorder characterized by incomplete relaxation of the lower esophageal sphincter and ineffective contraction of the esophageal body. This condition is not often associated with obesity; however, in recent years, cases of achalasia after bariatric surgery have been described. We describe the case of a 30-year-old female patient with a history of gastric sleeve surgery in 2018, which, 4 years after the intervention, presented with dysphagia, regurgitation, and weight loss.
View Article and Find Full Text PDFGastrointestinal (GI) motility is regulated in a large part by the cells of the enteric nervous system (ENS), suggesting that ENS dysfunctions either associate with, or drive GI dysmotility in patients. However, except for select diseases such as Hirschsprung's Disease or Achalasia that show a significant loss of all neurons or a subset of neurons, our understanding of human ENS histopathology is extremely limited. Recent endoscopic advances allow biopsying patient's full thickness gut tissues, which makes capturing ENS tissues simpler than biopsying other neuronal tissues, such as the brain.
View Article and Find Full Text PDFJ Gastroenterol
December 2024
Digestive Diseases Center, Showa University Koto-Toyosu Hospital, Tokyo, Japan.
Background: The distribution of body weight in patients with achalasia and after peroral endoscopic myotomy (POEM) has not been investigated. The role of body weight assessment after treatment remains unclear.
Methods: Using the multicenter achalasia cohort, the frequency of underweight (body mass index [BMI] < 18.
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