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achalasia review

Da Hyun Jung, Hyojin Park
Achalasia and gastroesophageal reflux disease (GERD) are on opposite ends of the spectrum of lower esophageal sphincter dysfunction. Heartburn is the main symptom of GERD. However, heartburn and regurgitation are frequently observed in patients who have achalasia. The diagnosis of achalasia might be delayed because these symptoms are misinterpreted as gastroesophageal reflux. Here, we reviewed the clinical characteristics of patients with the erroneous diagnosis of GERD who actually had untreated achalasia.
October 22, 2016: Journal of Neurogastroenterology and Motility
Fernando A M Herbella, Eduardo G H Moura, Marco G Patti
The treatment for achalasia changed dramatically after the introduction of minimally invasive surgery. Since 1991, laparoscopic Heller myotomy (LHM) has replaced pneumatic dilatation (PD) as the primary form of treatment in many centers. Over time, PD became safer, and eventually endoscopic experts were able to perform an endoscopic myotomy via a per oral endoscopic myotomy (POEM). This article reviews the advantages and disadvantages of each technique. Ultimately, the best outcomes are obtained by a multidisciplinary team that can tailor a specific treatment to each individual patient...
October 18, 2016: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
Brande Brown, Levon Agdere, Cornelia Muntean, Karen David
BACKGROUND Allgrove syndrome, or triple "A" syndrome (3A syndrome), is a rare autosomal recessive syndrome with variable phenotype, and an estimated prevalence of 1 per 1,000,000 individuals. Patients usually display the triad of achalasia, alacrima, and adrenocorticotropin (ACTH) insensitive adrenal insufficiency, though the presentation is inconsistent. CASE REPORT Here, the authors report a case of Allgrove syndrome in a pediatric patient with delayed diagnosis in order to raise awareness of this potentially fatal disease as a differential diagnosis of alacrima...
October 4, 2016: American Journal of Case Reports
Mario Masrur, Luis Fernando Gonzalez-Ciccarelli, Pier C Giulianotti
No abstract text is available yet for this article.
August 4, 2016: Surgery for Obesity and related Diseases: Official Journal of the American Society for Bariatric Surgery
Janette Furuzawa-Carballeda, Samuel Torres-Landa, Miguel Ángel Valdovinos, Enrique Coss-Adame, Luis A Martín Del Campo, Gonzalo Torres-Villalobos
Idiopathic achalasia is an archetype esophageal motor disorder, causing significant impairment of eating ability and reducing quality of life. The pathophysiological underpinnings of this condition are loss of esophageal peristalsis and insufficient relaxation of the lower esophageal sphincter (LES). The clinical manifestations include dysphagia for both solids and liquids, regurgitation of esophageal contents, retrosternal chest pain, cough, aspiration, weight loss and heartburn. Even though idiopathic achalasia was first described more than 300 years ago, researchers are only now beginning to unravel its complex etiology and molecular pathology...
September 21, 2016: World Journal of Gastroenterology: WJG
Saowanee Ngamruengphong, Haruhiro Inoue, Philip Chiu, Hon-Chi Yip, Amol Bapaye, Michael Ujiki, Lava Patel, Pankaj N Desai, Bu Hayee, Amyn Haji, Vivien Wong, Silvana Perretta, Shivangi Dorwat, Mathieu Pioche, Sabine Roman, Jérôme Rivory, François Mion, Thierry Ponchon, Aurélien Garros, Jun Nakamura, Yoshitaka Hata, Valerio Balassone, Manabu Onimaru, Gulara Hajiyeva, Amr Ismail, Yen-I Chen, Majidah Bukhari, Yamile Haito-Chavez, Vivek Kumbhari, Roberta Maselli, Alessandro Repici, Mouen A Khashab
BACKGROUND: Per-oral endoscopic myotomy (POEM) has shown promising safety and efficacy in short-term studies. However, long term follow-up data is very limited. The aims of this study were to assess (1) clinical outcome of patients with a minimum post-POEM follow-up of 2 years and (2) factors associated with long term clinical failure after POEM. METHODS: A retrospective chart review was performed that included all consecutive patients with achalasia who underwent POEM with a minimum follow-up of 2 years at 10 tertiary-care centers...
September 20, 2016: Gastrointestinal Endoscopy
Xuehong Wang, Yuyong Tan, Liang Lv, Hongyi Zhu, Yi Chu, Chenjie Li, Deliang Liu
BACKGROUND AND AIM: Both peroral endoscopic myotomy (POEM) and pneumatic dilation (PD) has proved to be effective for treating achalasia in patients aged ≥ 65 years. However little is known about the comparison between POEM and PD. The aim of the study was to compare the safety and efficacy of POEM and PD for the treatment of achalasia in these patients. METHODS: We retrospectively reviewed the medical records of patients aged 65 years-old or more who received POEM or PD for the treatment of achalasia at our hospital from January 2010 to December 2015, they were divided into the POEM group and the PD group...
October 2016: Revista Española de Enfermedades Digestivas
Oscar M Crespin, Louis W C Liu, Ambica Parmar, Timothy D Jackson, Jemila Hamid, Eran Shlomovitz, Allan Okrainec
INTRODUCTION: Peroral endoscopic myotomy (POEM) is a novel intervention for the treatment of achalasia, which combines the advantages of endoscopic access and myotomy. The purpose of this study was to perform a systematic review of the literature to evaluate the efficacy and safety of POEM. METHODS: The systematic review was conducted following the PRISMA guidelines. Evidence-Based Medicine Reviews, Cochrane Central Register of Controlled Trials, Ovid MEDLINE (R) including in-process and non-indexed citations were searched for POEM studies using the keywords: esophageal achalasia, POEM, endoscopy, natural orifice surgery, laparoscopic Heller myotomy (LHM), and related terms...
September 15, 2016: Surgical Endoscopy
Nithin Jayan, Jaya Susan Jacob, Mohan Mathew, Roy Joy Mukkada
BACKGROUND AND AIMS: Peroral endoscopic myotomy (POEM) is a safe and minimally invasive modality regarded as the first-line management of all types of achalasia. POEM is performed under general anesthesia with endotracheal intubation using an orally inserted flexible fiberscope. The aim of this study is to describe the anesthetic management of POEM for achalasia. MATERIAL AND METHODS: A chart review of 21 patients who underwent POEM for achalasia at our center from March 2013 to June 2015 was performed...
July 2016: Journal of Anaesthesiology, Clinical Pharmacology
Stavros N Stavropoulos, David Friedel, Rani Modayil, Henry P Parkman
Achalasia is a rare esophageal motility disorder that is usually idiopathic in origin. It is characterized by dysphagia, and patients often have chest pain, regurgitation, weight loss, and an abnormal barium radiograph showing esophageal dilation with narrowing at the gastroesophageal junction. Abnormal or absent esophageal peristalsis and impaired relaxation of the lower esophageal sphincter (LES) are typically seen on esophageal manometry. The advent of high resolution manometry (HRM) has allowed more precise diagnosis of achalasia, subtype designation, and differentiation from other esophageal motor disorders with an initial seminal publication in 2008 followed by further refinements of what has been termed the Chicago classification...
September 13, 2016: BMJ: British Medical Journal
Emmanuel Akintoye, Nitin Kumar, Itegbemie Obaitan, Quazim A Alayo, Christopher C Thompson
Background and study aim: Peroral endoscopic myotomy (POEM) is a relatively novel minimally invasive technique that is used to treat achalasia and other esophageal motility disorders. We systematically reviewed the medical literature in order to evaluate the safety and efficacy of POEM. Methods: We performed a comprehensive review and meta-analysis of studies published up to March 2016 that reported on clinical outcomes of POEM. Five databases were searched: MEDLINE, EMBASE, Ovid, CINAHL, and Cochrane. Results: A total of 36 studies involving 2373 patients were included in the review...
September 12, 2016: Endoscopy
Salih Samo, Dustin A Carlson, Dyanna L Gregory, Susan H Gawel, John E Pandolfino, Peter J Kahrilas
BACKGROUND & AIMS: Reported global incidence and prevalence values for achalasia vary widely, from 0.03 to 1.63/100,000 persons per year and from 1.8 to 12.6/100,000 persons per year, respectively. This study aimed to reconcile these low values with findings from a major referral center, in central Chicago (which began using high-resolution manometry in 2004 and used in it all clinical studies since 2005), and have determined the incidence and prevalence of achalasia to be much greater...
August 28, 2016: Clinical Gastroenterology and Hepatology
Stavros N Stavropoulos, Rani Modayil, David Friedel
Per-oral endoscopic myotomy has emerged as the preferred option for treatment of achalasia. This entirely endoscopic procedure has clinical efficacy and lower esophageal sphincter disruption comparable to laparoscopic Heller myotomy with lesser postprocedure pain and length of stay. This review describes per-oral endoscopic myotomy technique, evolution, patient selection, comparison to other therapies, training, and future considerations, including extrapolation of tunnel endoscopy to other situations.
2016: Seminars in Thoracic and Cardiovascular Surgery
Neelam G Gidwaney, Manisha Bajpai, Sita S Chokhavatia
The number of persons 60 years and older has increased 3-fold between 1950 and 2000. Aging alone does not greatly impact the gastrointestinal (GI) tract. Digestive dysfunction, including esophageal reflux, achalasia, dysphagia, dyspepsia, delayed gastric emptying, constipation, fecal incontinence, and fecal impaction, is a result of the highly prevalent comorbid conditions and the medications with which those conditions are treated. A multidisciplinary approach with the expertise of a geriatrician, gastroenterologist, neurologist, speech pathologist, and physical therapist ensures a comprehensive functional and neurological assessment of the older patient...
November 2016: Journal of Clinical Gastroenterology
Andreas M Schneider, Brian E Louie, Heather F Warren, Alexander S Farivar, Drew B Schembre, Ralph W Aye
BACKGROUND: Per oral endoscopic myotomy (POEM) is increasingly utilized to treat patients with achalasia. Early results have demonstrated significant improvement of symptoms, but there are concerns about postoperative reflux. With only limited comparative data available, we sought to compare POEM to laparoscopic Heller myotomy (LHM) with partial fundoplication. METHODS: This is a retrospective review of 42 POEM and 84 LHM patients undergoing primary myotomy for achalasia...
August 11, 2016: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
Yoshihito Souma, Kiyokazu Nakajima, Eiji Taniguchi, Tsuyoshi Takahashi, Yukinori Kurokawa, Makoto Yamasaki, Yasuhiro Miyazaki, Tomoki Makino, Tetsuhiro Hamada, Jun Yasuda, Takeyoshi Yumiba, Shuichi Ohashi, Shuji Takiguchi, Masaki Mori, Yuichiro Doki
BACKGROUND: Controversy remains whether preoperative pneumatic balloon dilation (PBD) influences the surgical outcome of laparoscopic esophagocardiomyotomy in patients with esophageal achalasia. The aim of this study was to evaluate whether preoperative PBD represents a risk factor for surgical complications and affects the symptomatic and/or functional outcomes of laparoscopic Heller myotomy with Dor fundoplication (LHD). METHODS: A retrospective chart review was conducted on a prospectively compiled surgical database of 103 consecutive patients with esophageal achalasia who underwent LHD from November 1994 to September 2014...
August 8, 2016: Surgical Endoscopy
Gulnur Gollu, Numan Demir, Ufuk Ates, Selen Serel Aslan, Ergun Ergun, Gonul Kucuk, Aydin Yagmurlu
AIM: Cricopharyngeal achalasia (CPA) is a rare clinical condition that is characterized by aspiration, choking, and nasopharyngeal regurgitation. The aim of this study is to introduce the outcomes of dilatation alone in children with CPA. PATIENTS AND METHOD: After the evaluation of upper esophageal sphincter with endoscopy, dilatation was performed. All patients underwent videofluoroscopic evaluation and swallowing therapy after the surgical procedure. A retrospective chart review was performed in children with CPA...
November 2016: Journal of Pediatric Surgery
Ravinder K Mittal
Muscularis propria throughout the entire gastrointestinal tract including the esophagus is comprised of circular and longitudinal muscle layers. Based on the studies conducted in the colon and the small intestine, for more than a century, it has been debated whether the two muscle layers contract synchronously or reciprocally during the ascending contraction and descending relaxation of the peristaltic reflex. Recent studies in the esophagus and colon prove that the two muscle layers indeed contract and relax together in almost perfect synchrony during ascending contraction and descending relaxation of the peristaltic reflex, respectively...
September 1, 2016: American Journal of Physiology. Gastrointestinal and Liver Physiology
Denys Gibbons, Michael Camilleri, Alfred D Nelson, Deborah Eckert
BACKGROUND: Gastrointestinal symptoms are frequent in multiple endocrine neoplasia (MEN) 2B and may be related to megacolon. OBJECTIVE: The objective of this article is to review the clinical features of patients with MEN 2B, particularly megacolon. METHODS: We used natural language processing of electronic medical records of Mayo Clinic patients over 20 years: Eight patients with definite MEN 2B were identified; of these, four had megacolon...
June 2016: United European Gastroenterology Journal
Basak Erginel, Feryal Gun Soysal, Erbug Keskin, Alaaddin Celik, Tansu Salman
Introduction The aim of this study was to review a single institution's experience with surgical interventions in children with achalasia and to determine treatment strategies for this rare disorder. Patients and methods This study is a retrospective analysis of 22 cases of childhood achalasia from 1991 to 2013. The patients were evaluated in terms of age, symptoms, interventions, intraoperative complications, and recurrent dysphagia. Results There were 13 boys and nine girls (7 months to 17 years old). The clinical symptoms were vomiting (68%), dysphagia (36%), wheezing (18%), coughing (13%), and weight-loss (13%)...
February 2016: Acta Chirurgica Belgica
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