Achalasia is a condition of loss of the ability of the esophagus to push food or drink from the mouth to the stomach. Achalasia commonly occurs in people with dysphagia to solids and fluids, and regurgitation is unresponsive to proton pump inhibitor therapy trials.
Diagnosis of Achalasia.
- Patients who are suspected of achalasia and show no evidence of mechanical obstruction on endoscopy or esophagram must undergo an esophageal motility test.
- There is an esophageal dilation, a narrow esophagogastric junction with features such as bird's beak, aperistalsis and poor barium emptying.
- Barium esophagram is recommended to assess esophageal emptying and esophagogastric junction morphology in people with questionable motility tests.
- It is recommended to conduct endoscopic assessment of the esophagogastric junction and gastric cardia in all patients with achalasia to rule out pseudoacalasia.
Treatment.
Initial therapy ➡
- Staged pneumatic dilatation or laparoscopic myotomy surgery with partial fundoplication.
- It is recommended to perform PD and myotomy surgery in high-volume superior centers.
Initial therapy must be adjusted to :
- Age.
- Gender.
- Patient preferences.
- Institutional expertise.
Botulinum toxin therapy is recommended in patients who are not recommended definitive therapy with PD or myotomy surgery.
Pharmacological therapy for achalasia is recommended for patients who are unwilling or unable to undergo definitive treatment with PD or myotomy surgery and have failed botulinum toxin therapy.
Follow-up.
Follow-up after therapy :
- Assessment of symptom improvement.
- Emptying the esophagus with a barium esophagram.
- Surveillance endoscopy for esophageal cancer is not recommended.
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