European guidelines on achalasia: United European Gastroenterology and European Society of Neurogastroenterology and Motility recommendations

Abstract

Introduction: Achalasia is a primary motor disorder of the oesophagus characterised by absence of peristalsis and insufficient lower oesophageal sphincter relaxation. With new advances and developments in achalasia management, there is an increasing demand for comprehensive evidence-based guidelines to assist clinicians in achalasia patient care.

Methods: Guidelines were established by a working group of representatives from United European Gastroenterology, European Society of Neurogastroenterology and Motility, European Society of Gastrointestinal and Abdominal Radiology and the European Association of Endoscopic Surgery in accordance with the Appraisal of Guidelines for Research and Evaluation II instrument. A systematic review of the literature was performed, and the certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation methodology. Recommendations were voted upon using a nominal group technique.

Results: These guidelines focus on the definition of achalasia, treatment aims, diagnostic tests, medical, endoscopic and surgical therapy, management of treatment failure, follow-up and oesophageal cancer risk.

Conclusion: These multidisciplinary guidelines provide a comprehensive evidence-based framework with recommendations on the diagnosis, treatment and follow-up of adult achalasia patients.

Keywords: Dysphagia; manometry; motility; myotomy; oesophagus.

Figure 1.

Interpretation of timed barium esophagram. Radiographs taken 0, 1, 2 and 5 minutes in left posterior oblique position after ingestion of 100 to 200 mL low-density barium suspension in an achalasia patient. Measurement of height and width of barium column, measured from the OGJ to the barium-foam interface. Barium height of >5 cm at 1 min and >2 cm at 5 min are suggestive of achalasia.