Achalasia: Insights into Diagnostic and Therapeutic Advances for an Ancient Disease

被引:9
|
作者
Mari, Amir [1 ,2 ,3 ]
Patel, Kalp [3 ]
Mahamid, Mahmud [1 ,2 ]
Khoury, Tawfik [1 ,2 ]
Pesce, Marcella [3 ]
机构
[1] Nazareth EMMS Hosp, Gastroenterol Inst, Nazareth, Israel
[2] Bar Ilan Univ, Azrieli Fac Med, Safed, Israel
[3] Univ Coll London Hosp, GI Physiol Unit, London, England
来源
RAMBAM MAIMONIDES MEDICAL JOURNAL | 2019年 / 10卷 / 01期
关键词
Achalasia; esophagogastric outflow obstruction; high-resolution manometry; per oral endoscopic myotomy (POEM); PERORAL ENDOSCOPIC MYOTOMY; LAPAROSCOPIC HELLER MYOTOMY; PNEUMATIC DILATION; CHICAGO CLASSIFICATION; ESOPHAGEAL MOTILITY; MANAGEMENT; OUTCOMES; EXPERIENCE; DISORDERS; POEM;
D O I
10.5041/RMMJ.10361
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Achalasia is a chronic idiopathic disease characterized by the absence of esophageal body peristalsis and by defective lower esophageal sphincter (LES) relaxation. The incidence rate ranges from 1.07 to up to 2.8 new cases per year per 100,000 population. Presenting symptoms include dysphagia, regurgitation, vomiting, and weight loss. The diagnosis of achalasia has undergone a revolution in the last decade due to the advent of high-resolution manometry (HRM) and the consequent development of the Chicago Classification. Recent progress has allowed achalasia to be more precisely diagnosed and to be categorized into three subtypes, based on the prevalent manometric features of the esophageal peristalsis. Treatment options are pharmacotherapy, endoscopic management (Botox injection or pneumatic dilation), and surgery, e.g. laparoscopic Heller myotomy (LHM). More recently, a new endoscopic technique, per oral endoscopic myotomy (POEM), has developed as a less invasive approach alternative to the traditional LHM. Since the first POEM procedure was performed in 2008, increasing evidence is accumulating regarding its efficacy and safety profiles. Currently, POEM is being introduced as a reasonable therapeutic option, though randomized controlled trails are still lacking. The current review sheds light onto the diagnosis and management of achalasia, with special focus on the recent advances of HRM and POEM.
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页数:9
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