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Review article: the management of achalasia – a comparison of different treatment modalities1
Article first published online: 31 AUG 2006
Alimentary Pharmacology & Therapeutics
Volume 24, Issue 6, pages 909–918, September 2006
How to Cite
LAKE, J. M. and WONG, R. K. H. (2006), Review article: the management of achalasia – a comparison of different treatment modalities. Alimentary Pharmacology & Therapeutics, 24: 909–918. doi: 10.1111/j.1365-2036.2006.03079.x
- Issue published online: 31 AUG 2006
- Article first published online: 31 AUG 2006
- Publication data Submitted 31 January 2006 First decision 18 February 2006 Resubmitted 29 June 2006 Accepted 2 July 2006
Achalasia is an uncommon primary oesophageal motor disorder with an unknown aetiology. Therapeutic options for achalasia are aimed at decreasing the lower oesophageal sphincter pressure, improving the oesophageal empting, and most importantly, relieving the symptoms of achalasia. Modalities for treatment include pharmacologic, endoscopic, pneumatic dilatation and surgical. The decision of which modality to use involves the consideration of multiple clinical and economic factors.
To review the management strategies currently available for achalasia.
A Medline search identified the original articles and reviews the published in the English language literature between 1966 and 2006.
The results reveal that pharmacotherapy, injection of botulinum toxin, pneumatic dilatation and minimally invasive surgical oesophagomyotomy are variably effective at controlling the symptoms of achalasia but that each modality has specific strengths and weaknesses which make them each suitable in certain populations. Overall, pharmacologic therapy results in the shortest lived, least durable response followed by botulinum toxin injection, pneumatic dilatation and surgery, respectively.
The optimal treatment for achalasia remains an area of controversy given our lack of complete understanding about the pathophysiology of the disease as well as the high numbers of clinical relapse after treatment. Further research focusing on optimal dosing of botulinum toxin injection and optimal timing of repeated graduated pneumatic dilatations could add to our knowledge regarding long-term therapy.