From the Guidelines
Achalasia is a rare esophageal disorder characterized by the presence of esophageal outflow obstruction at the esophagogastric junction (EGJ) and esophageal aperistalsis, which unifies the achalasia subtypes and directs interventional therapies to the lower esophageal sphincter (LES) 1. This condition is marked by the failure of the lower esophageal sphincter (LES) to relax properly, making it difficult for food and liquids to pass into the stomach.
- The main characteristics of achalasia include:
- Esophageal outflow obstruction at the EGJ
- Esophageal aperistalsis
- Failure of the LES to relax properly
- Difficulty swallowing (dysphagia)
- Regurgitation of undigested food
- Chest pain
- Heartburn
- Weight loss
- The diagnosis of achalasia typically involves tests such as barium swallow, endoscopy, and esophageal manometry, which help to identify the presence of esophageal outflow obstruction and aperistalsis 1.
- Treatment options for achalasia include per-oral endoscopic myotomy (POEM), laparoscopic Heller myotomy (LHM), and pneumatic dilation (PD), with the choice of treatment depending on the severity of symptoms, patient preferences, and local expertise 1.
- POEM is considered the preferred treatment for type III achalasia, which is characterized by spastic body contractions capable of luminal obliteration, due to its ability to provide unlimited proximal extension of myotomy 1.
From the Research
Definition of Achalasia
- Achalasia is a major esophageal motor disorder characterized by the altered relaxation of the esophagogastric junction in the absence of effective peristaltic activity 2
- It is a primary esophageal motility disorder featuring the absence of peristalsis in the esophageal body and inability of the lower esophageal sphincter to relax 3, 4
- Achalasia is a chronic incurable esophageal motility disorder characterized by impaired lower esophageal sphincter (LES) relaxation and loss of esophageal peristalsis 5
Symptoms of Achalasia
- Symptoms of achalasia include dysphagia to both solids and liquids, regurgitation, aspiration, chest pain, and weight loss 3, 5, 4
- Other less specific symptoms can also present, including heartburn, chronic cough, and aspiration pneumonia 2
- Patients with achalasia may present with long-standing and slowly progressive dysphagia to solids and liquids, heartburn, regurgitation, refractory reflux symptoms, and noncardiac chest pain 6
Diagnosis and Treatment of Achalasia
- The diagnosis of achalasia is suggested by barium swallow and endoscopy, and confirmed by manometry 3
- Treatment options for achalasia aim to disrupt the high-pressure lower esophageal sphincter to improve esophageal emptying, improve symptoms, and prevent further dilatation of the esophagus 6
- Current treatment modalities targeted at achalasia include pharmacological therapy, endoscopic therapy, and surgery, with options such as pneumatic dilation, Heller myotomy, and peroral endoscopic myotomy (POEM) 3, 5, 4, 6