Achalasia: An Update
Journal
Journal of Internal Medicine of Taiwan
Journal Volume
31
Journal Issue
6
Date Issued
2020-12-01
Author(s)
Abstract
Achalasia is an uncommon primary esophageal motility disorder, which causes impaired relaxation of the lower esophageal sphincter and absent esophageal peristalsis. It is associated with functional loss of myenteric plexus ganglion cells in the distal esophagus and lower esophageal sphincter. The initiation of neuronal degeneration may be an autoimmune process triggered by latent Herpes simplex virus type 1 infection in conjunction with a genetically susceptible host. The cardinal symptoms include dysphagia, typically to solids and liquids, regurgitation, chest pain and weight loss. Both barium swallow and esophagogastroduodenoscopy (EGD) reveal some clues of Achalasia, while they may be normal in early Achalasia. Timed barium esophagogram (TBE) further helps to assess the esophageal emptying after treatment. High resolution esophageal manometry (HRM) is the diagnostic gold standard, which classify Achalasia into 3 subtypes, and is considered mandatory before planning Achalasia therapy. Per-oral endoscopic myotomy (POEM) is a revolutionizing Achalasia therapy. A number of studies demonstrate that POEM produces comparable results compared to standard laparoscopic Heller myotomy (LHM) or pneumatic dilatation (PD). However, gastroesophageal reflux seemed to be more common among patients who underwent POEM; furthermore, few long-term follow-up studies are available. Longer duration of follow-up of patients who have undergone POEM is needed.
Type
other