Treatment of achalasia – the current approach and personal experience

Česká verzia

Authors: E. Veseliny; P. Jarčuška; M. Zakuciová; L. Gombošová; M. Janičko
Authors place of work: I. interná klinika LF UPJŠ a UNLP Košice
Published in the journal: Gastroent Hepatol 2012; 66(2): 116-124
Category: Clinical and Experimental Gastroenterology: Review Article

Summary

Achalasia is a primary oesophageal motor disorder of unknown etiology. It is characterized by incomplete lower oesophageal sphincter (LES) relaxation and aperistalsis of the oesophageal body. The cause of the disease remains elusive and there is no intervention that improves the oesophageal body function. Because of that, treatment options remain strictly palliative. Current treatments aim to reduce distal oesophageal obstruction, facilitate oesophageal emptying and improve dilation of the oesophagus. The two most effective treatment options are graded pneumatic dilation and surgical myotomy. This multicenter, randomized, international trial has confirmed the similar efficacy of these treatments, at least in the short term. Owing to a lack of long-term benefit, endoscopic botulinum toxin injection and pharmacologic therapy are reserved for those who are unable to undergo more effective invasive therapies. Clinical predictors of the outcome, patient preferences and local expertise should be considered when making a decision on the most appropriate treatment option. The value of new endoscopic and radiologic techniques, such as peroral endoscopic myotomy and oesophageal stenting, has not been fully established.

Key words:
achalasia – pneumatic dilation – Heller myotomy – botulinum toxin – POEM

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The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.