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2015, Number 4

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Revista Cubana de Cirugía 2015; 54 (4)

Therapeutical strategies in the treatment of esophageal achalasia

Jiménez RR, Roque GR, Anido EV

Language: Spanish
References: 20
Page: 318-326
PDF size: 110.15 Kb.


ABSTRACT

Introduction: achalasia is a neurodegenerative motility disorder of the esophagus resulting in failure of the lower esophageal sphincter to relax properly in response to swallowing and associated to motor disorder of the esophageal body. It affects both sex with an incidence rate of 1/100 000 and a prevalence of 10/100 000. Its pathophysiology includes immune, genetics, infectious and neurodegenerative factors that result in a selective loss of inhibitory neurons of the myenteric plexus and inflammatory infiltrate in the lower esophageal sphincter.
Objectives: to review the therapeutic modalities in the treatment of achalasia with short- and long-term analysis of treatment options.
Methods: through the introduction of high resolution manometry, a novel classification system for achalasia has been created to evaluate the prognosis of a patient and to predict response to treatment. Therapeutics is based on medical treatment, endoscopic procedures and surgery, being the latter the gold standard; however there is currently much debate over whether pneumatic dilation is better than Heller myotomy procedure in the treatment of achalasia.
Results: laparoscopic Heller myotomy has emerged in the last few years as the treatment of choice, particularly for young patients 45 years of age or younger. From November 2012 to September 2015, 27 endoscopic dilations have been perfomed in 15 women (55.6 %) and 12 men (44.4 %) with no reported complications. From January 2010 to December 2014, one hundred and eighty eight laparoscopic Heller myotomies were performed; the hospital stay was one day, neither conversion nor reoperation was necessary and the mortality rate was zero.


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