title: Achalasia: current treatment options.
abstract: Achalasia is a rare esophageal motility disorder, characterized by impaired swallow-induced, lower esophageal sphincter (LES) relaxation and defective esophageal peristalsis. Unfortunately, there are no etiological therapies for achalasia. Patients present with dysphagia, chest pain and regurgitation of undigested food, often leading to weight loss. The currently available treatments have the common aim of relieving symptoms by decreasing the pressure of the LES. This can be achieved with some medications, by inhibiting the cholinergic innervation (botulinum toxin), by stretching (endoscopic dilation) or cutting (surgery) the LES. Recently, other therapeutic options, including per-oral endoscopic myotomy have been developed and are gaining international consensus. The authors report on the benefits and weaknesses of the different therapies and provide an updated approach to the management of achalasia.
authors.affiliation: Digestive Endoscopy Unit - Gemelli University Hospital Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Familiari
authors.forename: Santi
authors.initials: S
authors.lastname: Greco
authors.forename: Ance
authors.initials: A
authors.lastname: Volkanovska
authors.forename: Giovanni
authors.initials: G
authors.lastname: Gigante
authors.forename: Anna
authors.initials: A
authors.lastname: Cali
authors.forename: Ivo
authors.initials: I
authors.lastname: Boškoski
authors.forename: Guido
authors.initials: G
authors.lastname: Costamagna
mesh_terms: D001905:Botulinum Toxins / Q000627:therapeutic use; D004106:Dilatation; D004931:Esophageal Achalasia / Q000601:surgery* / Q000628:therapy; D049630:Esophageal Sphincter, Lower / Q000601:surgery*; D016629:Esophagectomy; D004945:Esophagoscopy; D006801:Humans; D010535:Laparoscopy; D015607:Stents
chemical_list: D001905:Botulinum Toxins
keywords: POEM esophageal motility disorders; achalasia; botulinum toxin injection; dysphagia; esophageal manometry; esophageal myotomy; high-resolution manometry; pneumatic balloon dilation; surgery