title: The role of Heller myotomy and POEM for nonachalasia motility disorders.
abstract: The best-defined primary esophageal motor disorder is achalasia. However, symptoms such as dysphagia, regurgitation and chest pain can be caused by other esophageal motility disorders such as Diffuse Esophageal Spasm (DES), Nutcracker Esophagus (NE) and the Hypertensive Lower Esophageal Sphincter (HTN-LES). Most patients with DES and HTN-LES who complain of dysphagia improve after a myotomy. Patients with NE whose main complaint is chest pain, often do not have relief of the pain and can even develop dysphagia as a consequence of the myotomy. POEM is a relatively new procedure, and there are no studies with long-term follow-up and no prospective and randomized trials comparing it to surgical myotomy. Overall, the key to success is based on a complete evaluation and a careful patient selection. The best results, regardless of the technique, are in fact obtained in patients with outflow obstruction and impaired esophageal emptying, a picture similar to achalasia.
authors.affiliation: Departments of 1Surgery and Center for Esophageal Diseases and Swallowing.
authors.forename: F
authors.initials: F
authors.lastname: Schlottmann
authors.affiliation: Medicine and Center for Esophageal Diseases and Swallowing, University of North Carolina, Chapel Hill, North Carolina, USA.
authors.forename: N J
authors.initials: NJ
authors.lastname: Shaheen
authors.affiliation: Medicine and Center for Esophageal Diseases and Swallowing, University of North Carolina, Chapel Hill, North Carolina, USA.
authors.forename: R D
authors.initials: RD
authors.lastname: Madanick
authors.affiliation: Departments of 1Surgery and Center for Esophageal Diseases and Swallowing.
authors.forename: M G
authors.initials: MG
authors.lastname: Patti
mesh_terms: D015154:Esophageal Motility Disorders / Q000601:surgery*; D015155:Esophageal Spasm, Diffuse / Q000601:surgery*; D049630:Esophageal Sphincter, Lower / Q000601:surgery; D004947:Esophagus / Q000601:surgery*; D018662:Fundoplication / Q000379:methods; D006801:Humans; D006973:Hypertension / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods; D009055:Mouth / Q000601:surgery; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*
keywords: Heller myotomy; benign esophageal diseases; endoscopic treatment; esophageal motor disorders