An Overview of Achalasia Cardia
Keywords:
Achalasia, histopathology, weight loss, nutritionAbstract
Achalasia is one of the most studied esophageal motility disorders. However, the pathophysiology and reasons that patients develop achalasia are still unclear. Patients often present with dysphagia to solids and liquids, regurgitation, and varying degrees of weight loss. There is significant latency prior to diagnosis, which can have nutritional implications. The diagnosis is suspected based on clinical history and confirmed by esophageal high-resolution manometry testing. Esophagogastroduodenos copy is necessary to rule out potential malignancy that can mimic achalasia. Recent data presented in abstract form suggest that patients with type II achalasia may be most likely, and patients with type III achalasia may be least likely, to report weight loss compared to patients with type I achalasia. Although achalasia cannot be permanently cured, palliation of symptoms is possible in over 90% of patients with the treatment modalities currently available (pneumatic dilation, Heller myotomy, or peroral endoscopic myotomy). This article reviews the clinical presentation, diagnosis, and management options in patients with achalasia, as well as potential insights into histopathologic differences and nutritional implications of the subtypes of achalasia.
References
Patel DA, Vaezi MF. Achalasia and nutrition: is it simple physics or biology? Pract Gastroenterol. 2016;40(11):42–48. 9. Nenshi R, Takata J, Stegienko S, et al. The cost of achalasia: quantifying the effect of symptomatic disease on patient cost burden, treatment time, and work productivity. Surg Innov. 2010;17(4):291–294.
Birgisson S, Richter JE. Achalasia in Iceland, 1952-2002: an epidemiologic study. Dig Dis Sci. 2007;52(8):1855–1860.
Enestvedt BK, Williams JL, Sonnenberg A. Epidemiology and practice patterns of achalasia in a large multi-centre database. Aliment Pharmacol Ther. 2011;33(11):1209–1214.
Farrukh A, DeCaestecker J, Mayberry JF. An epidemiological study of achalasia among the South Asian population of Leicester, 1986-2005. Dysphagia. 2008;23(2):161–164.
Fisichella PM, Raz D, Palazzo F, Niponmick I, Patti MG. Clinical, radiological, and manometric profile in 145 patients with untreated achalasia. World J Surg. 2008;32(9):1974–1979.
Francis DL, Katzka DA. Achalasia: update on the disease and its treatment. Gastroenterology. 2010;139(2):369–374.
Kahrilas PJ, Bredenoord AJ, Fox M, et al. International High Resolution Manometry Working Group. The Chicago Classification of esophageal motility disorders, v3.0. Neurogastroenterol Motil. 2015;27(2):160–174.
Mikaeli J, Farrokhi F, Bishehsari F, Mahdavinia M, Malekzadeh R. Gender effect on clinical features of achalasia: a prospective study. BMC Gastroenterol. 2006;6:12.
Park W, Vaezi MF. Etiology and pathogenesis of achalasia: the current understanding. Am J Gastroenterol. 2005;100(6):1404–1414.
Patel DA, Naik RD, Slaughter JC, Higginbotham T, Silver HJ, Vaezi MF. Weight loss in achalasia is determined by its phenotype. Gastroenterology. 2017;152(5):S196.
Reas DL, Zipfel S, Rø Ø. Is it an eating disorder or achalasia or both? A literature review and diagnostic challenges. Eur Eat Disord Rev. 2014;22(5):321–330.
Sadowski DC, Ackah F, Jiang B, Svenson LW. Achalasia: incidence, prevalence and survival. A population-based study. Neurogastroenterol Motil. 2010;22(9):e256–e261.
Schechter RB, Lemme EM, Novais P, Biccas B. Achalasia in the elderly patient: a comparative study. Arq Gastroenterol. 2011;48(1):19–23.
Sinan H, Tatum RP, Soares RV, Martin AV, Pellegrini CA, Oelschlager BK. Prevalence of respiratory symptoms in patients with achalasia. Dis Esophagus. 2011;24(4):224–228.
Singaram C, Sengupta A, Sweet MA, Sugarbaker DJ, Goyal RK. Nitrinergic and peptidergic innervation of the human oesophagus. Gut. 1994;35(12):1690–1696.
Spechler SJ, Souza RF, Rosenberg SJ, Ruben RA, Goyal RK. Heartburn in patients with achalasia. Gut. 1995;37(3):305–308.
Uthayakumar N, Bates J. Case report: a difficult diagnosis to swallow. Malawi Med J. 2011;23(4):124–125.
Vaezi MF, Pandolfino JE, Vela MF. ACG clinical guideline: diagnosis and management of achalasia. Am J Gastroenterol. 2013;108(8):1238–1249.
Vantrappen G, Hellemans J, Deloof W, Valembois P, Vandenbroucke J. Treatment of achalasia with pneumatic dilatations. Gut. 1971;12(4):268–275.
Zifodya JS, Kim HP, Silver HJ, Slaughter JC, Higginbotham T, Vaezi M. Nutritional status of patients with untreated achalasia [abstract Tu1199] Gastroenterology. 2015;148(4):S-819–S-820.
