Copyright ©2009 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Oct 28, 2009; 15(40): 5000-5009
Published online Oct 28, 2009. doi: 10.3748/wjg.15.5000
Achalasia: A review of Western and Iranian experiences
Javad Mikaeli, Farhad Islami, Reza Malekzadeh
Javad Mikaeli, Farhad Islami, Reza Malekzadeh, Digestive Disease Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran 14117, Iran
Farhad Islami, International Agency for Research on Cancer, 69008 Lyon, France; King’s College London, Thames Cancer Registry, London SE1 3QD, United Kingdom
Author contributions: Mikaeli J, Islami F and Malekzadeh R reviewed the literature and wrote the paper
Correspondence to: Reza Malekzadeh, Professor, Digestive Disease Research Center, Tehran University of Medical Sciences, Shariati Hospital, Kargar Shomali Avenue, Tehran 14117, Iran. malek@ams.ac.ir
Telephone: +98-21-82415300 Fax: +98-21-82415400
Received: July 29, 2009
Revised: September 21, 2009
Accepted: September 28, 2009
Published online: October 28, 2009

Achalasia is a primary motor disorder of the esophagus, in which esophageal emptying is impaired. Diagnosis of achalasia is based on clinical findings. The diagnosis is confirmed by radiographic, endoscopic, and manometric evaluations. Several treatments for achalasia have been introduced. We searched the PubMed Database for original articles and meta-analyses about achalasia to summarize the current knowledge regarding this disease, with particular focus on different procedures that are used for treatment of achalasia. We also report the Iranian experience of treatment of this disease, since it could be considered as a model for medium-resource countries. Myotomy, particularly laparoscopic myotomy with fundoplication, is the most effective treatment for achalasia. Compared to other treatments, however, the initial cost of myotomy is usually higher and the recovery period is longer. When performing myotomy is not indicated or not possible, graded pneumatic dilation with slow rate of balloon inflation seems to be an effective and safe initial alternative. Injection of botulinum toxin into the lower esophageal sphincter before pneumatic dilation may increase remission rates. However, this needs to be confirmed in further studies. Due to lack of adequate information regarding the role of expandable stents in the treatment of achalasia, insertion of stents does not currently seem to be a recommended treatment. In summary, laparoscopic myotomy can be considered as the procedure of choice for treatment of achalasia. Graded pneumatic dilation is an effective alternative when the performance of myotomy is not possible for any reason.

Keywords: Achalasia, Esophagus, Motility, Treatment