Achalasia

Summary Achalasia is a rare motility disorder of the oesophagus characterised by loss of enteric neurons leading to absence of peristalsis and impaired relaxation of the lower oesophageal sphincter. Although its cause remains largely unknown, ganglionitis resulting from an aberrant immune response t...

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Bibliographic Details
Published in:The Lancet (British edition) 2014-01, Vol.383 (9911), p.83-93
Main Authors: Boeckxstaens, Guy E, Prof, Zaninotto, Giovanni, Prof, Richter, Joel E, Prof
Format: Article
Language:English
Subjects:
Autoimmune diseases
Biological and medical sciences
Cytokines
Dilatation - methods
Disease
Dysphagia
Early Detection of Cancer - methods
Epidemiology
Esophageal Achalasia - diagnosis
Esophageal Achalasia - epidemiology
Esophageal Achalasia - therapy
Esophageal Neoplasms - diagnosis
Esophagoscopy - methods
Esophagus
Food
Gastroenterology. Liver. Pancreas. Abdomen
Gastroesophageal reflux
General aspects
Humans
Immune response
Internal Medicine
Malformations
Manometry - methods
Medical sciences
Medical treatment
Minimally Invasive Surgical Procedures - methods
Mortality
Motility
Pain
Precancerous Conditions - diagnosis
Recurrence
Rodents
Studies
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Description
Summary:Summary Achalasia is a rare motility disorder of the oesophagus characterised by loss of enteric neurons leading to absence of peristalsis and impaired relaxation of the lower oesophageal sphincter. Although its cause remains largely unknown, ganglionitis resulting from an aberrant immune response triggered by a viral infection has been proposed to underlie the loss of oesophageal neurons, particularly in genetically susceptible individuals. The subsequent stasis of ingested food not only leads to symptoms of dysphagia, regurgitation, chest pain, and weight loss, but also results in an increased risk of oesophageal carcinoma. At present, pneumatic dilatation and Heller myotomy combined with an anti-reflux procedure are the treatments of choice and have comparable success rates. Per-oral endoscopic myotomy has recently been introduced as a new minimally invasive treatment for achalasia, but there have not yet been any randomised clinical trials comparing this option with pneumatic dilatation and Heller myotomy.
ISSN:0140-6736
1474-547X
DOI:10.1016/S0140-6736(13)60651-0