Management of Achalasia
Achalasia is a rare disorder of the esophagus caused by inflammation and subsequent degeneration of the ganglion cells of the myenteric plexus of the esophageal wall. This results in failure of the lower esophageal sphincter to relax with a loss of functional peristalsis in the lower esophagus. Achalasia is diagnosed by clinical symptoms, imaging, endoscopy, and manometric findings. For good surgical candidates, laparoscopic esophageal myotomy is the preferred therapeutic intervention. Patients can also be given the option of pneumatic dilation. Pharmacologic therapies are reserved for high-risk surgical candidates, in the form of endoscopic injections of botulinum toxin or oral medications, including calcium channel blockers, long-acting nitrates, or the phosphodiesterase-5 inhibitor, sildenafil.
KeywordsAchalasia Esophageal aperistalsis Corkscrew esophagus Esophageal myotomy Heller myotomy Pneumatic dilation
- 2.Pandolfino JE, Gawron AJ. Achalasia. JAMA [Internet]. 2015;313(18):1841. Available from: http://jama.jamanetwork.com/article.aspx?doi=10.1001/jama.2015.2996.CrossRefGoogle Scholar
- 7.Vaezi MF, Pandolfino JE, Vela MF. ACG clinical guideline: diagnosis and management of achalasia. Am J Gastroenterol [Internet] 2013;108(8):1238–49. Available from: http://www.nature.com/doifinder/10.1038/ajg.2013.196.CrossRefGoogle Scholar