[New concepts on the physiopathology, diagnosis, and treatment of achalasia].
OBJECTIVE
To review the most relevant publications on the pathophysiology, clinical manifestations, diagnosis and treatment of esophageal achalasia, and the clinical experience achieved at our institution in order to propose a practical strategy to facilitate the management of these patients.


METHODS
Manual and MEDLINE search of key articles published between January 1986 and July 1997 in addition to publications of our institute of thirty years.


METHODS
All kinds of publications with substantial clinical experience, new information or research protocols.


RESULTS
Achalasia is an uncommon disorder of the myenteric plexus of the esophagus. Main symptoms are dysphagia, regurgitations and chest pain. The diagnosis is established by manometric criteria. Esophagogram, endoscopy and radionuclide esophageal emptying test help to differentiate other conditions and evaluate the response to treatment. Pharmacotherapy may provide relief to patients with mild symptoms and is useful for patients with high risk of complications. Dilations and myotomy are safe, effective and long lasting procedures. Botulinum toxin may be effective in selected cases. Predictive factors of response have been described for each therapy.


CONCLUSIONS
A systematic approach to the management of patients with achalasia is necessary. Introduction of new therapies as botulinum toxin and minimal invasion surgery are changing the therapeutic decisions in this field. Drugs and BoTox are considered the first line of treatment for high risk patients and dilation and surgery for patients with no risk.
Departamento de Gastroenterología y, Instituto Nacional de la Nutrición Salvador Zubirán, México, D.F. rcarmona@aztlan.innsz.mx
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Carmona-Sánchez
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MA
Valdovinos-Díaz
D000328:Adult; D004931:Esophageal Achalasia / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male
Nuevos conceptos en fisiopatología, diagnóstico y tratamiento de la acalasia.