, Volume 58, Issue 3, pp 596-599
Date: 08 Jan 2013

New Treatments for Achalasia: Novel Ideas, but Are They Ready for Prime Time?

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Achalasia is a rare disorder (1/100,000 people per year) without any age or gender predilection [1]. Patients typically present with dysphagia for solids and liquids, regurgitation of undigested food, nocturnal coughing, chest pain, and weight loss. These symptoms result from impaired, usually absent, peristalsis and incomplete relaxation of the lower esophageal sphincter (LES) leading to stasis of food in the esophagus and esophageal dilation. Why the enteric esophageal neurons gradually disappear in patients with achalasia remains unknown. Evidence is accumulating that an autoimmune response targeted against these neurons, triggered by an infectious agent, possibly HSV-1, may be involved [2]. The diagnosis is made by a combination of tests including barium esophagram, esophageal manometry, and upper endoscopy.

No treatment for achalasia can restore muscular activity to the denervated esophagus; as a consequence, esophageal aperistalsis is rarely reversed. All treatments are thus direc ...