Achalasia: Symptoms, Pathogenesis & Treatments
In Achalasia, the neurons of Esophagus are degenerated for unknown reasons. As a result, the food in the esophagus does not go over normally. Also, LES does not work properly. Usually when food comes over
The LES relaxes and has to hand over the food, which is not done well and the food does not go over.
Symptoms of achalasia include dysphagia, chest pain, regurgiatation, and heartburn.
Treatment of Achalasia includes laparoscopic heller myotomy and endoscopic pneumodilation.
Heller myotomy is a surgical technique that cuts the LES of the cardia. Laparoscopy is used to inject the surgical instrument into the abdominal cavity and excision is performed from slightly above the LES to the upper part of the cardia. The esophagus consists of several layers, in which myotomy excludes only the outer muscle layer. This is because perforation occurs when resection to the inner mucosal layer.
Recently, peroral endoscopy myotomy has developed and myotomy is performed with an endoscope rather than a laparoscope. As mentioned above, the solution is injected into the submucosa with an endoscope needle to form a bleb, which is then inserted into the electrocautery. Then, the scopes are inserted and the esophagus myotomy is performed, the scopes are removed, the ligature is applied to the clip, and the procedure is finished. Several studies suggest that POEM has a better success rate than PD or LHM. The disadvantage, however, is that the long term effect is not yet known.
In PD, the procedure is initiated by the patient swallowing collapsed balloons. Then, place the balloon at the LES position, looking at the X-ray. After that, the balloon is dilatated to end the procedure by tearing the muscles of the narrowed LES. However, there is a disadvantage that a single dilatation is often insufficient.
The recent trend is that a lot of LHM is performed according to reports that LHM has a higher success rate. However, a study in Europe says that there is no big difference when PD or LHM shows a 5-year success rate or side-effect ratio. Both procedures can be recommended.
In summary, there is no significant difference between PD and LHM in terms of long-term success rate, and POEM has a higher success rate than PD or LHM according to short-term studies. However, more research is needed on the long term effect of POEM.
The LES relaxes and has to hand over the food, which is not done well and the food does not go over.
Symptoms of achalasia include dysphagia, chest pain, regurgiatation, and heartburn.
Treatment of Achalasia includes laparoscopic heller myotomy and endoscopic pneumodilation.
Heller myotomy is a surgical technique that cuts the LES of the cardia. Laparoscopy is used to inject the surgical instrument into the abdominal cavity and excision is performed from slightly above the LES to the upper part of the cardia. The esophagus consists of several layers, in which myotomy excludes only the outer muscle layer. This is because perforation occurs when resection to the inner mucosal layer.
Recently, peroral endoscopy myotomy has developed and myotomy is performed with an endoscope rather than a laparoscope. As mentioned above, the solution is injected into the submucosa with an endoscope needle to form a bleb, which is then inserted into the electrocautery. Then, the scopes are inserted and the esophagus myotomy is performed, the scopes are removed, the ligature is applied to the clip, and the procedure is finished. Several studies suggest that POEM has a better success rate than PD or LHM. The disadvantage, however, is that the long term effect is not yet known.
In PD, the procedure is initiated by the patient swallowing collapsed balloons. Then, place the balloon at the LES position, looking at the X-ray. After that, the balloon is dilatated to end the procedure by tearing the muscles of the narrowed LES. However, there is a disadvantage that a single dilatation is often insufficient.
The recent trend is that a lot of LHM is performed according to reports that LHM has a higher success rate. However, a study in Europe says that there is no big difference when PD or LHM shows a 5-year success rate or side-effect ratio. Both procedures can be recommended.
In summary, there is no significant difference between PD and LHM in terms of long-term success rate, and POEM has a higher success rate than PD or LHM according to short-term studies. However, more research is needed on the long term effect of POEM.
