Review
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World J Gastroenterol. Apr 14, 2012; 18(14): 1573-1578
Published online Apr 14, 2012. doi: 10.3748/wjg.v18.i14.1573
2011 update on esophageal achalasia
Seng-Kee Chuah, Pin-I Hsu, Keng-Liang Wu, Deng-Chyang Wu, Wei-Chen Tai, Chi-Sin Changchien
Seng-Kee Chuah, Keng-Liang Wu, Wei-Chen Tai, Chi-Sin Changchien, Division of Gastroenterology, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung 833, Taiwan
Pin-I Hsu, Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, National Yang-Ming University, Kaohsiung 813, Taiwan
Deng-Chyang Wu, Cancer Center, Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
Author contributions: Chuah SK and Hsu PI contributed equally to the paper, both drafted and wrote the article; Wu DC, Tai WC and Changchien CS revised the paper; and Wu KL approved the final version.
Correspondence to: Dr. Keng-Liang Wu, Division of Gastroenterology, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, 123 Ta-Pei Road, Niao-sung Hsiang, Kaohsiung 833, Taiwan. chuahsk@seed.net.tw
Telephone: +886-7-7317128301 Fax: +886-7-7322402
Received: September 14, 2011
Revised: December 6, 2011
Accepted: December 13, 2011
Published online: April 14, 2012
Abstract

There have been some breakthroughs in the diagnosis and treatment of esophageal achalasia in the past few years. First, the introduction of high-resolution manometry with pressure topography plotting as a new diagnostic tool has made it possible to classify achalasia into three subtypes. The most favorable outcome is predicted for patients receiving treatment for type II achalasia (achalasia with compression). Patients with typeI(classic achalasia) and type III achalasia (spastic achalasia) experience a less favorable outcome. Second, the first multicenter randomized controlled trial published by the European Achalasia Trial group reported 2-year follow-up results indicating that laparoscopic Heller myotomy was not superior to endoscopic pneumatic dilation (PD). Although the follow-up period was not long enough to reach a convincing conclusion, it merits the continued use of PD as a generally available technique in gastroenterology. Third, the novel endoscopic technique peroral endoscopic myotomy is a promising option for treating achalasia, but it requires increased experience and cautious evaluation. Despite all this good news, the bottom line is a real breakthrough from the basic studies to identify the actual cause of achalasia that may impede treatment success is still anticipated.

Keywords: Esophageal achalasia; High resolution manometry; Endoscopic pneumatic dilations; Minimally invasive surgical procedures; Peroral endoscopic myotomy