Review of Articles Clinical Presentation, Diagnostic Methods and Different Treatment Modalities of Achalasia

Abstract

Background: Achalasia is the most recognized esophageal motor disorder with an unknown etiology. Symptoms rather than physical findings are hallmarks of the disease. Modalilies for treatment include pharmacologic, botulinum toxin injection, pneumatic dilation and surgery.

Materials and Methods: To review the diagnostic and therapeutic options currently available for achalasia. A medline search identified the original articles and reviews published in the English language literature. We also reviewed our research center (Digestive Disease Research Center) articles.

Results: Pre and post treatment symptom score and timed esophagogram are important for assessment of treatment success rate. Pharmacotherapy, injection of botulinum toxin, pneumatic dilation and cardiomyotomy are variably effective at controlling the symptoms of achalasia but each modality has specific strengths and weaknesses which make them each suitable in certain population, but pneumatic dilation and surgery are the most effective options.

Conclusion: The optimal treatment for achalasia remains an area of controversy. In our opinion preumatic dilation is the best primary treatment in majority of Achalasia patients and Botulinum toxin injection and surgery should be reserved for patients that pneumatic dilation is high risk or ineffective in them.