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Review
. 2016 Apr 4:9:71-82.
doi: 10.2147/CEG.S84019. eCollection 2016.

Clinical management of achalasia: current state of the art

Joseph T Krill  1 , Rishi D Naik  1 , Michael F Vaezi  1
Affiliations
Review

Clinical management of achalasia: current state of the art

Joseph T Krill et al. Clin Exp Gastroenterol. .

Abstract

Achalasia is a primary disorder of esophageal motility. It classically presents with dysphagia to both solids and liquids but may be accompanied by regurgitation and chest pain. The gold standard for the diagnosis of achalasia is esophageal motility testing with manometry, which often reveals aperistalsis of the esophageal body and incomplete lower esophageal sphincter relaxation. The diagnosis is aided by complimentary tests, such as esophagogastroduodenoscopy and contrast radiography. Esophagogastroduodenoscopy is indicated to rule out mimickers of the disease known as "pseudoachalasia" (eg, malignancy). Endoscopic appearance of a dilated esophagus with retained food or saliva and a puckered lower esophageal sphincter should raise suspicion for achalasia. Additionally, barium esophagography may reveal a dilated esophagus with a distal tapering giving it a "bird's beak" appearance. Multiple therapeutic modalities aid in the management of achalasia, the decision of which depends on operative risk factors. Conventional treatments include medical therapy, botulinum toxin injection, pneumatic dilation, and Heller myotomy. The last two are defined as the most definitive treatment options. New emerging therapies include peroral endoscopic myotomy, placement of self-expanding metallic stents, and endoscopic sclerotherapy.

Keywords: Heller myotomy; achalasia; botulinum toxin injection; peroral endoscopic myotomy; pneumatic dilation; pseudoachalasia.

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Figures

Figure 1
Figure 1
(A–D) Diagnostic tests for achalasia. Notes: (A) Barium esophagram; (B) endoscopic appearance of achalasia; (C) chest computed tomography showing sigmoid esophagus; and (D) esophageal manometry showing type II achalasia.
Figure 1
Figure 1
(A–D) Diagnostic tests for achalasia. Notes: (A) Barium esophagram; (B) endoscopic appearance of achalasia; (C) chest computed tomography showing sigmoid esophagus; and (D) esophageal manometry showing type II achalasia.
Figure 1
Figure 1
(A–D) Diagnostic tests for achalasia. Notes: (A) Barium esophagram; (B) endoscopic appearance of achalasia; (C) chest computed tomography showing sigmoid esophagus; and (D) esophageal manometry showing type II achalasia.
Figure 2
Figure 2
Treatment algorithm for achalasia.
See this image and copyright information in PMC

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