Modern management of achalasia

Richter JE: Achalasia. In The Esophagus, edn 4. Edited by Castell DO, Richter JE. Philadelphia: Lippincott Williams and Wilkins, 2004: 221–261. Comprehensive review of the subject from A to Z.

Mayberry JF: Epidemiology and demographics of achalasia. Gastrointest Endosc Clin N Am 2001, 11: 235–247.

Goldblum JR, Whyte RI, Orringer MB, et al.: Achalasia: a morphologic study of 42 resected specimens. Am J Surg Pathol 1994, 18: 327–337. Excellent review of the gross and histologic findings in advanced achalasia.

Goldblum JR, Rice TW, Richter JE: Histopathologic features in esophagomyotomy specimens from patients with achalasia. Gastroenterology 1996, 111: 348–354. Excellent review of the early histologic features of achalasia with data suggesting vigorous achalasia is a distinct pathologic entity.

Holloway RH, Dodds WJ, Helms JF, et al.: Integrity of cholinergic innervation of the lower esophageal sphincter in achalasia. Gastroenterology 1996, 90: 924–929.

Vaezi MF, Richter JE: Practice guidelines: diagnosis and management of achalasia. Am J Gastroenterol 1999, 94: 3406–3412. Practice guidelines from the American College of Gastroenterology for the diagnosis and treatment of achalasia.

Goldenberg SP, Burrell M, Fette GG, et al.: Classic and vigorous achalasia: a comparison of manometric, radiographic and clinical findings. Gastroenterology 1991, 101: 743–748.

Katz PO, Richter JE, Cowan R, et al.: Apparent complete lower esophageal sphincter relaxation in achalasia. Gastroenterology 1986, 90: 978–983.

Hoogerwerf WA, Pasricha PJ: Pharmacologic therapy in treating achalasia. Gastrointest Endosc Clin N Am 2001, 11: 311–323.

Gelfand M, Rozen P, Gilat T: Isosorbide dinitrate and nifedipine treatment of achalasia: a clinical manometric and radionuclide evaluation. Gastroenterology 1982, 83: 963–969.

Triadafilopoulos G, Aaronson M, Sackel S, et al.: Medical treatment of esophageal achalasia. Doubleblind crossover study with oral nifedipine, verapamil and placebo. Dig Dis Sci 1991, 36: 260–227.

Fishman VM, Parkman HP, Schiano TD, et al.: Symptomatic improvement in achalasia after botulinum toxin injection of the lower esophageal sphincter. Am J Gastroenterol 1996, 91: 1724–1730.

Pasricha PJ, Rai R, Ravich WJ: Botulinum toxin for achalasia: long-term outcomes and predictors of success. Gastroenterology 1996, 110: 1410–1415. This review suggests older patients and those with vigorous achalasia have a more sustained relief to Botox injections.

Vaezi MF, Richter JE, Wilcox CM, et al.: Botulinum toxin versus pneumatic dilation in the treatment of achalasia: a randomized trial. Gut 1991, 44: 231–239.

Annese V, Bassotti G, Coccia G, et al.: A multi center randomized study of intrasphincteric botulinum toxin in oesphageal achalasia. Gut 2000, 46: 597–600.

Horgan S, Hudda K, Eubanks T, et al.: Does botulinum toxin injection make esophagomyotomy a more difficult operation? Surg Endosc 1999, 13: 576–579.

Panaccione R, Gregor JC, Reynolds RP, et al.: Intrasphincteric botulinum toxin versus pneumatic dilation for achalasia: a cost minimization analysis. Gastrointest Endosc 1999, 50: 492–498.

McJunkin B, McMillan WO, Duncan HE, et al.: Assessment of dilation methods in achalasia: large diameter necessary bougienage followed by pneumatic dilation as needed. Gastrointest Endosc 1991, 37: 18–21.

Chan KC, Wong SKH, Lee DWH, et al.: Short-term and long-term results of endoscopic balloon dilation for achalasia: 12 year’s experience. Endoscopy 2004, 36: 690–694.

Ghoshol UC, Kumar S, Saraswat VA, et al.: Long-term follow-up after pneumatic dilation for achalasia: factors associated with treatment failure and recurrence. Am J Gastroenterol 2004, 99: 2304–2310.

Karamanolis G, Sgouros S, Karatzias G, et al.: Long-term outcome of pneumatic dilation in the treatment of achalasia. Am J Gastroenterol 2005, 100: 270–274.

Guardino JM, Vela MF, Connor JT, Richter JE: Pneumatic dilation for the treatment of achalasia in untreated patients and patients with failed Heller myotomy. J Clin Gastroenterology 2004, 38: 855–860.

Farhoomad A, Connor JT, Richter JE, et al.: Predictors of outcome of pneumatic dilation in achalasia. Clin Gastroenterol Hepatol 2004, 2: 389–394.

Vela MF, Richter JE, Wachsberger D, et al.: Current treatments for achalasia are not curative: the long-term effects of pneumatic dilation and Heller myotomy. Gastroenterology 2004, 126: A326.

Parkman HP, Reynolds JC, Ouyang A, et al.: Pneumatic dilation or esophagomyotomy treatment for idiopathic achalasia: clinical outcomes and cost analysis. Dig Dis Sci 1993, 38: 75–85.

Imperiale TF, O’Connor B, Vaezi MF, Richter JE: A costminimization analysis of alternative treatment strategies for achalasia. Am J Gastroenterol 2000, 95: 2737–2745.

Oelschlager BK, Chang L, Pellegrini CA: Improved outcome after extended gastric myotomy for achalasia. Arch Surg 2003, 138: 490–495.

Richards WO, Torquati A, Holzman M, et al.: Heller myotomy versus Heller myotomy with Dor fundoplication for achalasia. A prospective randomized double-blind clinical trial. Ann Surg 2004, 240: 405–415. Single-center study showing that addition of Dor anterior fundoplication compared with myotomy alone significantly reduced the risk of complicated GERD (9% versus 48%, respectively).

Bloomston M, Rosemurgy AS: Selective application of fundoplication during laparoscopic Heller myotomy ensures favorable outcome. Surg Laparosc Endosc Percutan Tech 2002, 12: 309–315.

Frantizides C, Moore R, Carlson MA: Minimally invasive surgery for achalasia: a 10-year experience. J Gastrointest Surg 2004, 8: 18–23.

Gockel I, Junginger T, Berhard G, Eckhardt V: Heller myotomy for failed pneumatic dilation in achalasia. How effective is it? Ann Surg 2004, 239: 371–377. Previous pneumatic dilations did not affect the surgical techniques or long-term outcome of Heller myotomy. Compared with pneumatic dilation, young patients may benefit most from primary surgical therapy.

Sharp KW, Khaitan L, Scholz S, et al.: 100 consecutive minimally invasive Heller myotomies: lessons learned. Ann Surg 2002, 235: 631–639.

Guo JP, Gilman PB, Thomas RM, et al.: Barrett’s esophagus and achalasia. J Clin Gastroenterol 2002, 34: 439–443.

Csender A, Braghetto I, Henriques A, et al.: Late results of a prospective randomized study comparing forceful dilation and esophagomyotomy in patients with achalasia. Gut 1989, 30: 299–305.

Urbach DR, Hansen PD, Khajanchee YS, et al.: A decision analysis of the optimal initial approach to achalasia: laparoscopic Heller myotomy with partial fundoplication, thorascopic Heller myotomy, pneumatic dilation or botulinum toxin injection. J Gastrointest Surg 2001, 5: 191–205.

Orringer MB, Marshall B, Stirling MC: Transhiatal esophagectomy for benign and malignant disease. J Thorac Cardiovasc Surg 1993, 105: 265–275.

Katariya K, Harvey JC, Pina E, et al.: Complications of transhiatal esophagectomy. J Surg Oncol 1994, 57: 157–162.

Patti MG, Feo CV, Diener U, et al.: Laparoscopic Heller myotomy relieves dysphagia in achalasia when the esophagus is dilated. Surg Endosc 1999, 13: 843–846.

Vela MF, Richter JE, Wachsberger D, et al.: Complexities of managing achalasia at a tertiary referral center: use of pneumatic dilation, Heller myotomy and botulinum toxin injection. Am J Gastroenterol 2004, 99: 1029–1036. Successful management of achalasia can be complex and may require more than one treatment modality. Overall, more than 90% of patients will do well.