the Management of Achalasia

- Introduction

Achalasia is a primary esophageal motor disorder of unknown etiology characterized by degeneration of the myenteric plexus, which results in impaired relaxation of the esophagogastric junction (EGJ), along with the loss of organized peristalsis in the esophageal body. The criterion standard for diagnosing achalasia is higher solution esophageal manometry showing incomplete relaxation of the EGJ coupled with the absence of organized peristalsis. Three achalasia subtypes have been defined based on high-resolution manometry findings in the esophageal body, ⁽¹⁾.

Other treatment options include botulinum toxin injection, pneumatic dilation, and Heller myotomy. Esophageal motor abnormalities in achalasia lead to symptoms of dysphagia for solids and liquids without oropharyngeal transfer difficulties in roughly 90% of patients, regurgitation in 75%, weight loss in 60%, chest pain in 50%, and heartburn in 40%, ⁽²⁾.

Treatment of patients with achalasia has evolved in recent years with the introduction of peroral endoscopic myotomy, ⁽²⁾.