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achalasia review

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https://www.readbyqxmd.com/read/29440962/focal-achalasia-case-report-and-review-of-the-literature
#1
Marcus Joachim Herzig, Radu Tutuian
Esophageal achalasia is a primary smooth muscle motility disorder specified by aperistalsis of the tubular esophagus in combination with a poorly relaxing and occasionally hypertensive lower esophageal sphincter (LES). These changes occur secondary to the destruction of the neural network coordinating esophageal peristalsis and LES relaxation (plexus myentericus). There are limited data on segmental involvement of the esophagus in adults. We report on the case of a 54-year-old man who presented initially with complete aperistalsis limited to the distal esophagus...
2018: Clujul Medical (1957)
https://www.readbyqxmd.com/read/29439587/clinical-management-of-pediatric-achalasia
#2
Marinde van Lennep, Michiel P van Wijk, Taher I Omari, Marc A Benninga, Maartje M J Singendonk
Achalasia is a rare esophageal motility disorder. Much of the literature is based on the adult population. In adults, guidance of therapeutic approach by manometric findings has led to improvement in patient outcome. Promising results have been achieved with novel therapies such as PerOral Endoscopic Myotomy (POEM). Areas covered: In this review, we provide an overview of the novel diagnostic and therapeutic tools for achalasia management and in what way they will relate to the future management of pediatric achalasia...
February 13, 2018: Expert Review of Gastroenterology & Hepatology
https://www.readbyqxmd.com/read/29410262/laparoscopic-heller-myotomy-vs-per-oral-endoscopic-myotomy-patient-reported-outcomes-at-a-single-institution
#3
Andrew N Hanna, Jashodeep Datta, Sara Ginzberg, Kevin Dasher, Gregory G Ginsberg, Daniel T Dempsey
INTRODUCTION: While laparoscopic Heller myotomy (LHM) has been tstandard of care for achalasia, per oral endoscopic myotomy (POEM) has gained popularity as a viable alternative. This retrospective study aims to compare patient reported outcomes between LHM and POEM in a consecutive series of achalasia patients with more than 1 year follow-up. METHODS: Demographic and procedure-related data for patients who underwent either LHM or POEM for achalasia between January 2011 and May 2016 were reviewed...
February 1, 2018: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/29406039/the-effect-of-race-in-patients-with-achalasia-diagnosed-with-high-resolution-esophageal-manometry
#4
Victor Chedid, Elizabeth Rosenblatt, Kunjal Komal Gandhi, Sameer Dhalla, Monica C Nandwani, Ellen M Stein, John O Clarke
BACKGROUND: The advent of the Chicago Classification for esophageal motility disorders allowed for clinically reproducible subgrouping of patients with achalasia based on manometric phenotype. However, there are limited data with regards to racial variation using high-resolution esophageal manometry (HREM). The aim of our study was to evaluate the racial differences in patients with achalasia diagnosed with HREM using the Chicago Classification. We evaluated the clinical presentation, treatment decisions and outcomes between blacks and non-blacks with achalasia to identify potential racial disparities...
February 2018: American Journal of the Medical Sciences
https://www.readbyqxmd.com/read/29380066/outcomes-and-quality-of-life-assessment-after-per-oral-endoscopic-myotomy-poem-performed-in-the-endoscopy-unit-with-trainees
#5
Sunil Dacha, Lei Wang, Xaioyu Li, Yueping Jiang, George Philips, Steven A Keilin, Field F Willingham, Qiang Cai
BACKGROUND: Per oral endoscopic myotomy (POEM) has emerged as a promising option for the treatment of achalasia. This study assessed POEM training process, outcomes, and improvement in quality of life after POEM performed by an interventional endoscopist (mentor) with trainees. METHODS: We performed a retrospective review of data for patients who underwent POEM with involvement of trainees. Trainees were trained in performing mucosotomy, submucosal dissection, creating submucosal tunnel, identifying gastroesophageal junction, myotomy, and closure of mucosal incision in a step-by-step fashion...
January 29, 2018: Surgical Endoscopy
https://www.readbyqxmd.com/read/29377271/-management-of-achalasia-cardia-expert-consensus-statements
#6
REVIEW
Mohan Ramchandani, D Nageshwar Reddy, Zaheer Nabi, Radhika Chouhan, Amol Bapaye, Shobhna Bhatia, Nilay Mehta, Pankaj Dhawan, Adarsh Chaudhary, Uday Ghoshal, Mathew Philip, Horst Neuhaus, Jacques Deviere, Haruhiro Inoue
Achalasia cardia (AC) is a frequently encountered motility disorder of the esophagus resulting from an irreversible degeneration of neurons. Treatment modalities are palliative in nature and there is no curative treatment available for AC as of now. Significant advancements have been made in the management of AC over last decade. The introduction of high resolution manometry (HRM) and per-oral endoscopic myotomy (POEM) have strengthened the diagnostic and therapeutic armamentarium of AC. HRM allows for the characterization of the type of achalasia which in turn has important therapeutic implications...
January 29, 2018: Journal of Gastroenterology and Hepatology
https://www.readbyqxmd.com/read/29356303/rapid-drink-challenge-test-during-esophageal-high-resolution-manometry-in-patients-with-esophago-gastric-junction-outflow-obstruction
#7
D Biasutto, F Mion, A Garros, S Roman
BACKGROUND: Esophago-gastric junction (EGJ) outflow obstruction is of unclear significance. Rapid drink challenge (RDC) test is easy to perform during esophageal high resolution manometry. We aimed to assess the yield of RDC test in patients with EGJ outflow obstruction. METHODS: Manometry studies of patients with EGJ outflow obstruction according to the Chicago Classification v3.0 were retrospectively reviewed. Pan-esophageal pressurization (PEP), esophageal shortening, and pressure gradient across the EGJ were analyzed during RDC test (200-mL free drinking in sitting position) and compared according to the causes of EGJ outflow obstruction determined by charts review...
January 22, 2018: Neurogastroenterology and Motility: the Official Journal of the European Gastrointestinal Motility Society
https://www.readbyqxmd.com/read/29350340/poem-in-the-treatment-of-esophageal-disorders
#8
REVIEW
Nasim Parsa, Mouen A Khashab
OPINION STATEMENT: PURPOSE OF THE REVIEW: Peroral endoscopic myotomy (POEM) is a novel minimally invasive technique that has emerged as the preferred option for the treatment of achalasia and spastic esophageal disorders (SED) at many centers around the world. In this article, we review and summarize the recent literature on POEM in patients with achalasia and SED. The current article is largely focused on the new developments and findings, extended applications, and long-term outcomes of POEM in patients with achalasia and SED...
January 19, 2018: Current Treatment Options in Gastroenterology
https://www.readbyqxmd.com/read/29349541/per-oral-endoscopic-myotomy-early-experience-and-safety-of-a-multispecialty-approach
#9
Evgeny V Arshava, Raffaele J Marchigiani, Henning Gerke, Rami El Abiad, Ronald J Weigel, Kalpaj R Parekh, John Keech
BACKGROUND: Per oral endoscopic myotomy (POEM) has gained increasing popularity for treating achalasia. A multidisciplinary approach may allow safe and early adoption of POEM into clinical practice. MATERIALS AND METHODS: We performed a retrospective review of our initial POEM cases. All procedures were performed by a team of interventional gastroenterologist and thoracic surgeon. We analyzed demographics, comorbidities, achalasia subtypes, length of hospital stay, duration of surgery, morbidity, mortality, length of myotomy, preoperative and postoperative Eckardt scores...
January 18, 2018: Surgical Endoscopy
https://www.readbyqxmd.com/read/29343964/achalasia-following-reflux-disease-coincidence-consequence-or-accommodation-an-experience-based-literature-review
#10
András Vereczkei, Laura Bognár, András Papp, Örs Péter Horváth
Achalasia is a motility disorder of the esophagus characterized by the defective peristaltic activity of the esophageal body and impaired relaxation of the lower esophageal sphincter due to the degeneration of the inhibitory neurons in the myenteric plexus of the esophageal wall. The histopathological and pathophysiological changes in achalasia have been well described. However, the exact etiological factors leading to the disease still remain unclear. Currently, achalasia is believed to be a multifactorial disease, involving both extrinsic and intrinsic factors...
2018: Therapeutics and Clinical Risk Management
https://www.readbyqxmd.com/read/29319024/what-to-do-when-heller-s-myotomy-fails-pneumatic-dilatation-laparoscopic-remyotomy-or-peroral-endoscopic-myotomy-a-systematic-review
#11
REVIEW
Sonia Fernández-Ananín, Arnulfo F Fernández, Carmen Balagué, David Sacoto, Eduardo Maria Targarona
BACKGROUND: Surgical treatment of achalasia fails in 10%-20% of patients. The most frequent responsible cause is the performance of an incomplete myotomy at primary surgery. The treatment when the failure happens is not well defined. In this study, we review and evaluate the possible treatments to be carried out when surgical myotomy fails. We define its benefits and results, with the purpose of defining a therapeutic algorithm. MATERIALS AND METHODS: The systematic review was performed following the guidelines established by the Meta-analysis of Observational Studies in Epidemiology statement...
January 10, 2018: Journal of Minimal Access Surgery
https://www.readbyqxmd.com/read/29180348/phenotype-genotype-spectrum-of-aaa-syndrome-from-western-india-and-systematic-review-of-literature
#12
Hiren Patt, Katrin Koehler, Sailesh Lodha, Swati Jadhav, Chaitanya Yerawar, Angela Huebner, Kunal Thakkar, Sneha Arya, Sandhya Nair, Manjunath Goroshi, Hosahithlu Ganesh, Vijaya Sarathi, Anurag Lila, Tushar Bandgar, Nalini Shah
OBJECTIVE: To study genotype-phenotype spectrum of triple A syndrome (TAS). METHODS: Retrospective chart analysis of Indian TAS patients (cohort 1, n = 8) and review of genotyped TAS cases reported in world literature (cohort 2, n = 133, 68 publications). RESULTS: Median age at presentation was 4.75 years (range: 4-10) and 5 years (range: 1-42) for cohorts 1 and 2, respectively. Alacrima, adrenal insufficiency (AI), achalasia and neurological dysfunction (ND) were seen in 8/8, 8/8, 7/8 and 4/8 patients in cohort 1, and in 99, 91, 93 and 79% patients in cohort 2, respectively...
November 2017: Endocrine Connections
https://www.readbyqxmd.com/read/29156013/a-novel-strategy-to-initiate-a-peroral-endoscopic-myotomy-program
#13
J Matthew Reinersman, Dennis A Wigle, Christopher J Gostout, Louis M Wong Kee Song, Shanda H Blackmon
OBJECTIVES: The standard of care for achalasia remains laparoscopic Heller myotomy with partial fundoplication. Peroral endoscopic myotomy (POEM) has been introduced as an alternative, but safety and long-term comparative efficacy are not yet established. We report our experience in developing a POEM program using a novel hybrid approach. METHODS: We developed a hybrid approach to POEM with a POEM followed by laparoscopic evaluation, extension of the myotomy, if necessary, and partial fundoplication...
October 1, 2017: European Journal of Cardio-thoracic Surgery
https://www.readbyqxmd.com/read/29134329/esophageal-motility-disorders-new-perspectives-from-high-resolution-manometry-and-histopathology
#14
REVIEW
Hiroki Sato, Kazuya Takahashi, Ken-Ichi Mizuno, Satoru Hashimoto, Junji Yokoyama, Go Hasegawa, Shuji Terai
High-resolution manometry (HRM) and peroral endoscopic myotomy (POEM) have contributed significantly to the field of esophageal motility disorders in recent years. The development of HRM has categorized various esophageal motility disorders with a focus on a diverse range of manometric anomalies. Additionally, the Chicago classification criteria is widely used for manometric diagnosis. Moreover, POEM was introduced as a minimally invasive radical therapy for achalasia and shows promise for other spastic esophageal motility disorders as well...
November 13, 2017: Journal of Gastroenterology
https://www.readbyqxmd.com/read/29102729/gastroesophageal-reflux-disease-after-per-oral-endoscopic-myotomy-as-compared-with-heller-s-myotomy-with-fundoplication-a-systematic-review-with-meta-analysis
#15
REVIEW
Alessandro Repici, Lorenzo Fuccio, Roberta Maselli, Fabrizio Mazza, Loredana Correale, Daniele Mandolesi, Cristina Bellisario, Amrita Sethi, Mouen Kashab, Thomas Rösch, Cesare Hassan
BACKGROUND AND AIMS: Per-oral endoscopic myotomy (POEM) represents a less invasive alternative, as compared with conventional laparoscopic Heller's myotomy (LHM), for achalasia patients. It cannot be excluded, however, that the lack of fundoplication after POEM may result in a higher incidence of reflux disease, as compared with LHM. The aim was to conduct a systematic review of prospective studies reporting the incidence of reflux disease developed after POEM and LHM. METHODS: Literature search with electronic databases was performed (up to February 2017) to identify full articles on the incidence of gastro-esophageal reflux symptoms, endoscopic- and pH-monitoring-findings after POEM and LHM (with fundoplication)...
November 1, 2017: Gastrointestinal Endoscopy
https://www.readbyqxmd.com/read/29078682/the-current-state-of-per-oral-endoscopic-myotomy-for-achalasia
#16
REVIEW
Shane P Smith, Brian E Louie
Achalasia is an acquired neuromuscular disorder that has been treated using a variety of modalities throughout medical history. Recently, the technique of per oral endoscopic myotomy (POEM) was introduced to treat the disease using a truly minimally invasive, natural orifice technique that is rapidly being adopted across the world. This review outlines the development of POEM, the technique itself, and gives a comparison to other procedures, specifically laparoscopic Heller myotomy (LHM).
2017: Journal of visualized surgery
https://www.readbyqxmd.com/read/29022068/esophagectomy-for-end-stage-achalasia-systematic-review-and-meta-analysis
#17
REVIEW
Alberto Aiolfi, Emanuele Asti, Gianluca Bonitta, Luigi Bonavina
BACKGROUND: Indications for surgery and clinical outcomes of esophagectomy in the management of end-stage achalasia are not clearly defined. The aim of this systematic review and meta-analysis was to provide evidence-based information to help in the decision-making and in the choice of surgical technique. METHODS: An extensive literature search was conducted to identify all reports on esophagectomy for end-stage achalasia patients over the past three decades. MEDLINE, Embase and Cochrane databases were thoroughly consulted matching the terms "achalasia," "end-stage achalasia," "esophagectomy" and "esophageal resection" with "AND" and "OR...
October 11, 2017: World Journal of Surgery
https://www.readbyqxmd.com/read/28989059/clinical-practice-update-the-use-of-per-oral-endoscopic-myotomy-in-achalasia-expert-review-and-best-practice-advice-from-the-aga-institute
#18
REVIEW
Peter J Kahrilas, David Katzka, Joel E Richter
The purpose of this review is to describe a place for per-oral endoscopic myotomy (POEM) among the currently available robust treatments for achalasia. The recommendations outlined in this review are based on expert opinion and on relevant publications from PubMed and EMbase. The Clinical Practice Updates Committee of the American Gastroenterological Association proposes the following recommendations: 1) in determining the need for achalasia therapy, patient-specific parameters (Chicago Classification subtype, comorbidities, early vs late disease, primary or secondary causes) should be considered along with published efficacy data; 2) given the complexity of this procedure, POEM should be performed by experienced physicians in high-volume centers because an estimated 20-40 procedures are needed to achieve competence; 3) if the expertise is available, POEM should be considered as primary therapy for type III achalasia; 4) if the expertise is available, POEM should be considered as treatment option comparable with laparoscopic Heller myotomy for any of the achalasia syndromes; and 5) post-POEM patients should be considered high risk to develop reflux esophagitis and advised of the management considerations (potential indefinite proton pump inhibitor therapy and/or surveillance endoscopy) of this before undergoing the procedure...
November 2017: Gastroenterology
https://www.readbyqxmd.com/read/28958274/age-and-achalasia-how-does-age-affect-patient-presentation-hospital-course-and-surgical-outcomes
#19
Darrell J Downs, Giavanna Jadick, Forat Swaid, Sharona B Ross, Alexander S Rosemurgy
Heller myotomy is the "gold-standard" therapy for achalasia, alleviating symptoms by defunctionalizing the lower esophageal sphincter mechanism. Observation has suggested many differences between young and old patients with achalasia, raising the question: is achalasia in younger patients a different disorder than it is in older patients? This study was undertaken to answer this question. With Institutional Review Board approval, 648 patients undergoing laparoscopic Heller myotomy from 1992-2016 were prospectively followed up...
September 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28881885/igg4-related-disease-involving-the-esophagus-a-clinicopathological-study
#20
I Obiorah, A Hussain, C Palese, N Azumi, S Benjamin, M Ozdemirli
Immunoglobulin G4 (IgG4)-related disease is a recently coined systemic disease characterized by specific histopathologic findings of an intense lymphoplasmacytic infiltrate, storiform fibrosis, and obliterative phlebitis in the presence of predominant IgG4-positive plasma cells. Although IgG4-related disease has been described in many organs, involvement of the esophagus is very rare. In this study, we describe the clinicopathologic characteristics of eight patients with IgG4-related esophagitis. We evaluated chronic esophagitis specimens with lymphoplasmacytic infiltrate obtained over the past 6 years (from January 2011 to February 2017) using a chart review, pathologic examination, and IgG4 immunohistochemical staining...
December 1, 2017: Diseases of the Esophagus: Official Journal of the International Society for Diseases of the Esophagus
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