title: Diagnosis and Treatment Strategy of Achalasia Subtypes and Esophagogastric Junction Outflow Obstruction Based on High-Resolution Manometry.
abstract: BACKGROUND
  Based on Chicago Classification version 3.0, the disorders of esophagogastric junction outflow obstruction (EGJOO) include achalasia (types I, II and III) and EGJOO. Although no curative treatments are currently available for the treatment of the disorders of EGJOO, medical treatments, endoscopic pneumatic dilation (PD), laparoscopic Heller myotomy (LHM), and per-oral endoscopic myotomy (POEM) are usually the sought-after modes of treatment. Since the etiology and pathogenesis might vary depending on the types of EGJOO disorders, treatment strategies should be considered based on those subtypes.
  
  
  CONCLUSIONS
  Based on the accumulated evidences, the treatment strategies of our institution are as follows: effects of medical treatments on achalasia are limited. Either PD or LHM/POEM can be considered a first-line in achalasia type I, according to the patient's wish. PD and POEM can be considered first-line in achalasia types II and III, respectively. Conversely, In EGJOO, medical treatments including drugs like acotiamide and/or diltiazem can be tested as a first-line, and PD and POEM will be considered second and third-line treatments, respectively. Key Messages: The classification of subtypes based on high-resolution manometry will help us consider which treatment option can be selected as a first-line treatment depending upon the subtypes of disorders of EGJOO. Acotiamide has the potential to cure patients with EGJOO.
authors.affiliation: Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Eikichi
authors.initials: E
authors.lastname: Ihara
authors.forename: Kazumasa
authors.initials: K
authors.lastname: Muta
authors.forename: Keita
authors.initials: K
authors.lastname: Fukaura
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Nakamura
mesh_terms: D001549:Benzamides / Q000627:therapeutic use; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D004106:Dilatation / Q000379:methods; D004110:Diltiazem / Q000627:therapeutic use; D004931:Esophageal Achalasia / Q000145:classification / Q000175:diagnosis* / Q000628:therapy*; D004935:Esophageal Diseases / Q000145:classification / Q000175:diagnosis* / Q000628:therapy*; D004943:Esophagogastric Junction / Q000503:physiopathology*; D004945:Esophagoscopy / Q000379:methods; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008365:Manometry / Q000379:methods; D013844:Thiazoles / Q000627:therapeutic use
chemical_list: D001549:Benzamides; D002121:Calcium Channel Blockers; D013844:Thiazoles; C410959:Z 338; D004110:Diltiazem