title: Achalasia: from diagnosis to management.
abstract: Achalasia is an esophageal motility disorder associated with abnormalities in peristalsis and lower esophageal sphincter (LES) relaxation. The etiology of the disease remains elusive. It is often misdiagnosed initially as gastroesophageal reflux disease. Patients with achalasia often complain of dysphagia to solids and liquids but may focus on regurgitation as the primary symptom, leading to the early misdiagnosis. Chest pain, weight loss, and occasional vomiting may be additional symptoms encountered in those with achalasia. The disease may be suspected on the basis of clinical presentation, but diagnosis depends on classic findings using high-resolution manometry, showing either failed or simultaneous contractions with associated normal or high LES pressures with no or incomplete relaxation with swallows. There are no cures for achalasia, and, in most patients, treatments have to be repeated over time. Definitive treatment options in achalasia include pneumatic dilation, surgical myotomy, and the new technique of per-oral endoscopic myotomy. Botulinum toxin (Botox) or other medical therapies are often reserved for those who cannot have definitive therapies owing to comorbid conditions.
authors: Division of Gastroenterology, Hepatology, and Nutrition, Center for Swallowing and Esophageal Disorders, Vanderbilt University Medical Center, Nashville, Tennessee. Michael.vaezi@vanderbilt.edu.
authors: Michael F
authors: MF
authors: Vaezi
authors: FMUSP and Nucleus of General and Specialized Surgery, Sao Paulo, Brazil.
authors: Valter N
authors: VN
authors: Felix
authors: Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, and Department of Pathophysiology and Transplantation, Università degli Studi, Milan, Italy.
authors: Roberto
authors: R
authors: Penagini
authors: Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, and Department of Pathophysiology and Transplantation, Università degli Studi, Milan, Italy.
authors: Aurelio
authors: A
authors: Mauro
authors: Gastrointestinal Endoscopy Unit, Department of Gastrointestinal Surgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
authors: Eduardo Guimarães Hourneaux
authors: EG
authors: de Moura
authors: Gastrointestinal Endoscopy Unit, Department of Gastrointestinal Surgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
authors: Leonardo Zorrón Cheng Tao
authors: LZ
authors: Pu
authors: Department of Hepatogastroenterology, IKEM, Prague, Czech Republic.
authors: Jan
authors: J
authors: Martínek
authors: Department of Surgery, Medical University of Vienna, Vienna, Austria.
authors: Erwin
authors: E
authors: Rieder
mesh_terms: D000818:Animals; D001905:Botulinum Toxins / Q000627:therapeutic use; D002637:Chest Pain / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D019468:Disease Management; D004931:Esophageal Achalasia / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D004945:Esophagoscopy / Q000379:methods; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D008365:Manometry / Q000379:methods
chemical_list: D001905:Botulinum Toxins
keywords: POEM; botulinum toxin; pneumatic dilation; surgical myotomy