Achalasia: A review of Western and Iranian Experiences and Studies

Abstract

Achalasia is a primary motor disorder of the esophagus, in which esophageal emptying is impaired. Diagnosis of achalasia is based on clinical findings and confirmed by radiologic, 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 utilized for treatment. We also report the Iranian experience of treatment of this disease, since it could be considered as a model for medium-resource countries. Laparoscopic myotomy with fundoplication is the best surgical method for treatment of achalasia with its high success rate and therapeutic response. Compared to other treatments, however, the initial cost of myotomy is usually higher and the recovery period is longer. Graded pneumatic dilation with a 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 the 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 surgical treatment of achalasia. Graded pneumatic dilation is an effective alternative and can be recommended as a first therapeutic option in the majority of achalasia patients.