Treatments for Achalasia in 2017: How to choose among them

Peter J. Kahrilas*, John E. Pandolfino

*Corresponding author for this work

Research output: Contribution to journalReview article

10 Scopus citations

Abstract

Purpose of review To review recent advances in achalasia diagnostics and therapeutics. Recent findings The cardinal feature of achalasia, impaired lower esophageal sphincter (LES) relaxation, can occur in association with varied patterns of esophageal contractility. The Chicago Classification distinguishes among these as follows: without contractility (type I), with panesophageal pressurization (type II), with premature (spastic) distal esophageal contractions (type III), or even with preserved peristalsis [esophagogastric junction (EGJ) outlet obstruction]. Physiological testing also reveals achalasia-like syndromes that also benefit from achalasia therapies. Coincident with this has been the development of peroral endoscopic myotomy (POEM), an endoscopic technique for performing an esophageal myotomy. Hence, the option now exists to either selectively ablate the LES (pneumatic dilation, laparoscopic Heller myotomy, or POEM) or to ablate the sphincter and create a myotomy along some or the entire adjacent smooth muscle esophagus (POEM). Each achalasia syndrome has unique treatment considerations; type II achalasia responds well to all therapies, whereas type III responds best to POEM. Summary Emerging data support the concept that optimal management of achalasia is phenotype-specific, guided by high-resolution manometry, and, in some instance, functional luminal imaging probe studies. This opinion article reviews the varied characteristic and treatment considerations of achalasia syndromes as currently understood.

Original languageEnglish (US)
Pages (from-to)270-276
Number of pages7
JournalCurrent Opinion in Gastroenterology
Volume33
Issue number4
DOIs
StatePublished - Jul 1 2017

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Keywords

  • Achalasia
  • esophageal motility disorders
  • functional luminal imaging probe
  • high-resolution manometry
  • peroral endoscopic myotomy

ASJC Scopus subject areas

  • Gastroenterology

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