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Current Treatment Options in Gastroenterology

, Volume 14, Issue 4, pp 420–428 | Cite as

Finding the Right Treatment for Achalasia Treatment: Risks, Efficacy, Complications

  • An Moonen
  • Guy Boeckxstaens
Motility (H Parkman and R Schey, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Motility

Opinion statement

Achalasia is a primary esophageal motor disorder of the esophagus that is characterized by the absence of esophageal peristalsis and a failure of the lower esophageal sphincter (LES) to relax upon swallowing. The defective relaxation leads to symptoms of dysphagia for solids and liquids, regurgitation, aspiration, chest pain, and weight loss. Achalasia is believed to result from a selective loss of enteric inhibitory neurons, most likely due to an autoimmune phenomenon in genetic susceptible individuals. As there is no curative treatment for achalasia, treatment is confined to disruption of the LES to improve bolus passage. The two most commonly used treatment modalities available are the endoscopic pneumodilation (PD) and the surgical laparoscopic Heller myotomy (LHM). A recent European randomized controlled trial showed that both treatment modalities have comparable success rates after a follow-up of at least 5 years. In view of these data, both treatments can be used as an initial therapy in achalasia and the choice should be based on the expertise available. Recently, a new endoscopic technique, peroral endoscopic myotomy (POEM), has been introduced with excellent short-term success rates. However, longer follow-up and data from randomized controlled trials are needed before accepting this technique as a new treatment option for achalasia in clinical practice.

Keywords

Achalasia Pneumatic dilation Laparoscopic Heller myotomy Peroral endoscopic myotomy 

Notes

Compliance with Ethical Standards

Conflict of Interest

An Moonen declares that she has no conflict of interest.

Guy Boeckxstaens declares that he has no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Copyright information

© Springer Science+Business Media, LLC 2016

Authors and Affiliations

  1. 1.Department of Gastroenterology, Translational Research Center for Gastrointestinal Disorders (TARGID)University Hospital Leuven, Catholic University LeuvenLeuvenBelgium

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