Top

Published in:

Open Access 01-02-2010 | DeMeester Feschrift

A Controversy That Has Been Tough to Swallow: Is the Treatment of Achalasia Now Digested?

Authors: Garrett R. Roll, Charlotte Rabl, Ruxandra Ciovica, Sofia Peeva, Guilherme M. Campos

Published in: Journal of Gastrointestinal Surgery | Special Issue 1/2010

Abstract

Esophageal achalasia is a rare neurodegenerative disease of the esophagus and the lower esophageal sphincter that presents within a spectrum of disease severity related to progressive pathological changes, most commonly resulting in dysphagia. The pathophysiology of achalasia is still incompletely understood, but recent evidence suggests that degeneration of the postganglionic inhibitory nerves of the myenteric plexus could be due to an infectious or autoimmune mechanism, and nitric oxide is the neurotransmitter affected. Current treatment of achalasia is directed at palliation of symptoms. Therapies include pharmacological therapy, endoscopic injection of botulinum toxin, endoscopic dilation, and surgery. Until the late 1980s, endoscopic dilation was the first line of therapy. The advent of safe and effective minimally invasive surgical techniques in the early 1990s paved the way for the introduction of laparoscopic myotomy. This review will discuss the most up-to-date information regarding the pathophysiology, diagnosis, and treatment of achalasia, including a historical perspective. The laparoscopic Heller myotomy with partial fundoplication performed at an experienced center is currently the first line of therapy because it offers a low complication rate, the most durable symptom relief, and the lowest incidence of postoperative gastroesophageal reflux.

Ruffato A, Mattioli S, Lugaresi ML, Lugaresi ML, D'Ovidio F, Antonacci F, Di Simone MP. Long-term results after Heller–Dor operation for oesophageal achalasia. Eur J Cardiothorac Surg 2006;29:914–919.PubMed

Podas T, Eaden J, Mayberry M, Mayberry J. Achalasia: a critical review of epidemiological studies. Am J Gastroenterol 1998;93:2345–2347.PubMed

Birgisson S, Richter JE. Achalasia: what's new in diagnosis and treatment? Dig Dis 1997;15(Suppl 1):1–27.PubMed

Bennett JR, Hendrix TR. Treatment of achalasia with pneumatic dilatation. Mod Treat 1970;7:1217–1228.PubMed

Bonatti H, Hinder RA, Klocker J, Neuhaser B, Klaus A, Achem SR, de Vault K. Long-term results of laparoscopic Heller myotomy with partial fundoplication for the treatment of achalasia. Am J Surg 2005;190:874–878.PubMed

Rosemurgy A, Villadolid D, Thometz D, Kalipersad C, Rakita S, Albrink M, Johnson M, Boyce W. Laparoscopic Heller myotomy provides durable relief from achalasia and salvages failures after botox or dilation. Ann Surg 2005;241:725–733. discussion 733–725.PubMed

Frantzides CT, Moore RE, Carlson MA, Maden AK, Zografakis JG, Keshavarian A, Smith C. Minimally invasive surgery for achalasia: a 10-year experience. J Gastrointest Surg 2004;8:18–23.PubMed

Zaninotto G, Costantini M, Molena D, Buin F, Carta A, Nicoletti L, Ancona E. Treatment of esophageal achalasia with laparoscopic Heller myotomy and Dor partial anterior fundoplication: prospective evaluation of 100 consecutive patients. J Gastrointest Surg 2000;4:282–289.PubMed

Oelschlager BK, Chang L, Pellegrini CA. Improved outcome after extended gastric myotomy for achalasia. Arch Surg 2003;138:490–495. discussion 495–497.PubMed

10.

Patti MG, Fisichella PM, Perretta S, Galvani C, Gorodner MV, Robinson T, Way LW. Impact of minimally invasive surgery on the treatment of esophageal achalasia: a decade of change. J Am Coll Surg 2003;196:698–703. discussion 703–695.PubMed

11.

Patti MG, Tamburini A, Pellegrini CA. Cardiomyotomy. Semin Laparosc Surg 1999;6:186–193.PubMed

12.

Deb S, Deschamps C, Allen MS, Nichols FC, Cassivi SD, Crownhart BS, Pairolero PC. Laparoscopic esophageal myotomy for achalasia: factors affecting functional results. Ann Thorac Surg 2005;80:1191–1194. discussion 1194–1195.PubMed

13.

Ackroyd R, Watson DI, Devitt PG, Jamieson GG. Laparoscopic cardiomyotomy and anterior partial fundoplication for achalasia. Surg Endosc 2001;15:683–686.PubMed

14.

Nguyen NQ, Holloway RH. Recent developments in esophageal motor disorders. Curr Opin Gastroenterol 2005;21:478–484.PubMed

15.

Goldblum JR, Whyte RI, Orringer MB, Appelman HD. Achalasia. A morphologic study of 42 resected specimens. Am J Surg Pathol 1994;18:327–337.PubMed

16.

Wong RK, Maydonovitch CL, Metz SJ, Baker JR Jr. Significant DQw1 association in achalasia. Dig Dis Sci 1989;34:349–352.PubMed

17.

Howard PJ, Maher L, Pryde A, Cameron EW, Heading RC. Five year prospective study of the incidence, clinical features, and diagnosis of achalasia in Edinburgh. Gut 1992;33:1011–1015.PubMed

18.

Castagliuolo I, Brun P, Costantini M, Rissetto C, Palu G, Costantino M, Baldan N, Zaninotto G. Esophageal achalasia: is the herpes simplex virus really innocent? J Gastrointest Surg 2004;8:24–30. discussion 30.PubMed

19.

Castex F, Guillemot F, Talbodec N, Colombel JF, Paris JC, Cortot A. Association of an attack of varicella and an achalasia. Am J Gastroenterol 1995;90:1188–1189.PubMed

20.

Boeckxstaens GE. Achalasia: virus-induced euthanasia of neurons? Am J Gastroenterol 2008;103:1610–1612.PubMed

21.

Zayat EN, Schuster MM. Nitric oxide—a major player in esophageal motility. Am J Gastroenterol 2000;95:1584–1585.PubMed

22.

Tutuian R, Castell D. Review article: oesophageal spasm—diagnosis and management. Aliment Pharmacol Ther 2006;23:1393–1402.PubMed

23.

Holloway RH, Dodds WJ, Helm JF, Hogan WJ, Dent J, Armdorfer RC. Integrity of cholinergic innervation to the lower esophageal sphincter in achalasia. Gastroenterology 1986;90:924–929.PubMed

24.

Sivarao DV, Mashimo HL, Thatte HS, Goyal RK. Lower esophageal sphincter is achalasic in nNOS(−/−) and hypotensive in W/W(v) mutant mice. Gastroenterology 2001;121:34–42.PubMed

25.

Mearin F, Mourelle M, Guarner F, Salas A, Riveros-Moreno V, Moncada S, Malagelada JR. Patients with achalasia lack nitric oxide synthase in the gastro-oesophageal junction. Eur J Clin Invest 1993;23:724–728.PubMed

26.

Balaji NS, Peters JH. Minimally invasive surgery for esophageal motility disorders. Surg Clin North Am 2002;82:763–782.PubMed

27.

Kraichely RE, Farrugia G. Achalasia: physiology and etiopathogenesis. Dis Esophagus 2006;19:213–223.PubMed

28.

Dogan I, Mittal RK. Esophageal motor disorders: recent advances. Curr Opin Gastroenterol 2006;22:417–422.PubMed

29.

Gockel I, Bohl JR, Junginger T. Achalasia: new insights in pathogenesis. Am J Gastroenterol 2006;101:202–203.PubMed

30.

Richter JE. Oesophageal motility disorders. Lancet 2001;358:823–828.PubMed

31.

Stylopoulos N, Bunker CJ, Rattner DW. Development of achalasia secondary to laparoscopic Nissen fundoplication. J Gastrointest Surg 2002;6:368–376. discussion 377–378.PubMed

32.

DeMeester TR. Surgery for esophageal motor disorders. Ann Thorac Surg 1982;34:225–229.PubMed

33.

Wong RKH, Maydonovitch CL. Achalasia. In Castell DO, Richter J, eds. The esophagus, 3rd ed. Philadelphia: Lippincott, WIlliams and Wilkins, 1999, pp 185–213.

34.

Pandolfino JE, Kahrilas PJ. AGA technical review on the clinical use of esophageal manometry. Gastroenterology 2005;128:209–224.PubMed

35.

Agrawal A, Hila A, Tutuian R, Castell DO. Manometry and impedance characteristics of achalasia. Facts and myths. J Clin Gastroenterol 2008;42:266–270.PubMed

36.

Creamer B, Ellis FH Jr., Olsen AM. Cardiospasm (achalasia of the cardia). Am J Surg 1957;93:299–307.PubMed

37.

Bondi JL, Godwin DH, Garrett JM. “Vigorous” achalasia. Its clinical interpretation and significance. Am J Gastroenterol 1972;58:145–155.PubMed

38.

Camacho-Lobato L, Katz PO, Eveland J, Vela M, Castell DO. Vigorous achalasia: original description requires minor change. J Clin Gastroenterol 2001;33:375–377.PubMed

39.

Spechler SJ, Castell DO. Classification of oesophageal motility abnormalities. Gut 2001;49:145–151.PubMed

40.

Goldenberg SP, Burrell M, Fette GG, Vos C, Traube M. Classic and vigorous achalasia: a comparison of manometric, radiographic, and clinical findings. Gastroenterology 1991;101:743–748.PubMed

41.

Kahrilas PJ, Sifrim D. High-resolution manometry and impedance–pH/manometry: valuable tools in clinical and investigational esophagology. Gastroenterology 2008;135:756–769.PubMed

42.

Pandolfino JE, Kwiatek MA, Nealis T, Bulsiewicz W, Post J, Kahrilas PJ. Achalasia: a new clinically relevant classification by high-resolution manometry. Gastroenterology 2008;135:1526–1533.PubMed

43.

Bredenoord AJ, Tutuian R, Smout AJ, Castell DO. Technology review: esophageal impedance monitoring. Am J Gastroenterol 2007;102:187–194.PubMed

44.

Crookes PF, Corkill S, DeMeester TR. Gastroesophageal reflux in achalasia. When is reflux really reflux? Dig Dis Sci 1997;42:1354–1361.PubMed

45.

Cheadle WG, Vitale GC, Sadek S, Cuschieri A. Evidence for reflux in patients with achalasia. Dis Surg 1988;5:1–4.

46.

Lemme EM, Domingues GR, Pereira VL, Firman CG, Pantoja J. Lower esophageal sphincter pressure in idiopathic achalasia and Chagas disease-related achalasia. Dis Esophagus 2001;14:232–234.PubMed

47.

Boeckxstaens GE, Jonge WD, van den Wijngaard RM, Benninga MA. Achalasia: from new insights in pathophysiology to treatment. J Pediatr Gastroenterol Nutr 2005;41(Suppl 1):S36–S37.PubMed

48.

Koberle F. Chagas’ disease and Chagas’ syndromes: the pathology of American trypanosomiasis. Adv Parasitol 1968;6:63–116.PubMed

49.

Moonka R, Patti MG, Feo CV, Arecerito M, De Pinto M, Horgan S, Pellegrini CA. Clinical presentation and evaluation of malignant pseudoachalasia. J Gastrointest Surg 1999;3:456–461.PubMed

50.

Del Genio A, Fei L, Di Martino N, Napolitano V, Landolfi V, Maffettone V, Fusco F, Ruggiero R. Acute aperistaltic megaesophagus as a complication of Nissen fundoplication: a case report. Ital J Surg Sci 1984;14:135–138.PubMed

51.

Gockel I, Eckardt VF, Schmitt T, Junginger T. Pseudoachalasia: a case series and analysis of the literature. Scand J Gastroenterol 2005;40:378–385.PubMed

52.

Proctor DD, Fraser JL, Mangano MM, Calkins DR, Rosenberg SJ. Small cell carcinoma of the esophagus in a patient with longstanding primary achalasia. Am J Gastroenterol 1992;87:664–667.PubMed

53.

Ziegler K, Sanft C, Friedrich M, Gregor M, Riecken EO. Endosonographic appearance of the esophagus in achalasia. Endoscopy 1990;22:1–4.PubMed

54.

de Oliveira JM, Birgisson S, Doinoff C, Einstein D, Herts B, Davros W, Obuchowski N, Koehler RE, Richter J, Baker ME. Timed barium swallow: a simple technique for evaluating esophageal emptying in patients with achalasia. AJR Am J Roentgenol 1997;169:473–479.PubMed

55.

Oezcelik A, Hagen JA, Halls JM, Leers JM, Abate E, Ayazi S, Zehetner J, DeMeester SR, Banki F, Lipham JC, DeMeester TR. An improved method of assessing esophageal emptying using the timed barium study following surgical myotomy for achalasia. J Gastrointest Surg 2008;13:14–18.PubMed

56.

Hoogerwerf WA, Pasricha PJ. Pharmacologic therapy in treating achalasia. Gastrointest Endosc Clin N Am 2001;11:311–324. vii.PubMed

57.

Wen ZH, Gardener E, Wang YP. Nitrates for achalasia. Cochrane Database Syst Rev 2004:CD002299. doi:002210.001002/14651858.CD14002299.pub14651852.

58.

Wong RK, Maydonovitch C, Garcia JE, Johnson LF, Castell DO. The effect of terbutaline sulfate, nitroglycerin, and aminophylline on lower esophageal sphincter pressure and radionuclide esophageal emptying in patients with achalasia. J Clin Gastroenterol 1987;9:386–389.PubMed

59.

DiMarino AJ Jr., Cohen S. Effect of an oral beta2-adrenergic agonist on lower esophageal sphincter pressure in normals and in patients with achalasia. Dig Dis Sci 1982;27:1063–1066.PubMed

60.

Marzio L, Grossi L, DeLaurentiis MF, Cennamo L, Lapenna D, Cuccurullo F. Effect of cimetropium bromide on esophageal motility and transit in patients affected by primary achalasia. Dig Dis Sci 1994;39:1389–1394.PubMed

61.

Penagini R, Bartesaghi B, Negri G, Bianchi PA. Effect of loperamide on lower oesophageal sphincter pressure in idiopathic achalasia. Scand J Gastroenterol 1994;29:1057–1060.PubMed

62.

Willis T. Pharmaceutice rationalis sive diatribe de medicamentorum operationibus in human corpore. London: Hagae Comitis, 1674.

63.

Witzel L. Treatment of achalasia with a pneumatic dilator attached to a gastroscope. Endoscopy 1981;13:176–177.PubMed

64.

Jankovic J, Brin MF. Therapeutic uses of botulinum toxin. N Engl J Med 1991;324:1186–1194.PubMed

65.

Roberts KE, Duffy AJ, Bell RL. Controversies in the treatment of gastroesophageal reflux and achalasia. World J Gastroenterol 2006;12:3155–3161.PubMed

66.

Campos GM, Vittinghoff E, Rabl C, Takata M, Gadenstatter M, Lin F, Ciovica R. Endoscopic and surgical treatments for achalasia—a systematic review and meta-analysis. Ann Surg 2009;249:45–57.PubMed

67.

Annese V, Bassotti G, Coccia G, Dinelli M, D'Onofrio V, Gatto G, Leandro G, Repici A, Testoni PA, Andriulli A. A multicentre randomised study of intrasphincteric botulinum toxin in patients with oesophageal achalasia. GISMAD Achalasia Study Group. Gut 2000;46:597–600.PubMed

68.

Pasricha PJ, Rai R, Ravich WJ, Hendrix TR, Kalloo AN. Botulinum toxin for achalasia: long-term outcome and predictors of response. Gastroenterology 1996;110:1410–1415.PubMed

69.

Fishman VM, Parkman HP, Schiano TD, Hills C, Dabezies MA, Cohen S, Fisher RS, Miller LS. Symptomatic improvement in achalasia after botulinum toxin injection of the lower esophageal sphincter. Am J Gastroenterol 1996;91:1724–1730.PubMed

70.

Annese V, Basciani M, Perri F, Lombadi G, Frusciante V, Simone P, Andrulli A, Vantrappen G. Controlled trial of botulinum toxin injection versus placebo and pneumatic dilation in achalasia. Gastroenterology 1996;111:1418–1424.PubMed

71.

Morino M, Rebecchi F, Festa V, Garrone C. Preoperative pneumatic dilatation represents a risk factor for laparoscopic Heller myotomy. Surg Endosc 1997;11:359–361.PubMed

72.

Portale G, Costantini M, Rizzetto C, Guirroli E, Ceolin M, Salvador R, Ancona E, Zaninotto G. Long-term outcome of laparoscopic Heller–Dor surgery for esophageal achalasia: possible detrimental role of previous endoscopic treatment. J Gastrointest Surg 2005;9:1332–1339.PubMed

73.

Abir F, Modlin I, Kidd M, Bell R. Surgical treatment of achalasia: current status and controversies. Dig Surg 2004;21:165–176.PubMed

74.

Vaezi MF, Richter JE. Current therapies for achalasia: comparison and efficacy. J Clin Gastroenterol 1998;27:21–35.PubMed

75.

Rai RR, Shende A, Joshi A, Mathur A, Nijhawan S. Rigiflex pneumatic dilation of achalasia without fluoroscopy: a novel office procedure. Gastrointest Endosc 2005;62:427–431.PubMed

76.

Eckardt VF, Aignherr C, Bernhard G. Predictors of outcome in patients with achalasia treated by pneumatic dilation. Gastroenterology 1992;103:1732–1738.PubMed

77.

Leyden JE, Moss AC, MacMathuna P. Endoscopic pneumatic dilation versus botulinum toxin injection in the management of primary achalasia. Cochrane Database Syst Rev 2006:CD005046.

78.

Wehrmann T, Jacobi V, Jung M, Lembcke B, Caspary WF. Pneumatic dilation in achalasia with a low-compliance balloon: results of a 5-year prospective evaluation. Gastrointest Endosc 1995;42:31–36.PubMed

79.

Aguilar-Paiz LA, Valdovinos-Diaz MA, Flores-Soto C et al. Prospective evaluation of gastroesophageal reflux in patients with achalasia treated with pneumatic dilatation, thoracic or abdominal myotomy. Rev Invest Clin 1999;51:345–350.PubMed

80.

Karamanolis G, Sgouros S, Karatzias G, Papdopoulou E, Vasiliadis K, Stefanidis G, Mantides A. Long-term outcome of pneumatic dilation in the treatment of achalasia. Am J Gastroenterol 2005;100:270–274.PubMed

81.

Mainie I, Tutuian R, Castell DO. The limitations of pH monitoring for detecting gastroesophageal reflux. Clin Gastroenterol Hepatol 2006;4:1184. author reply 1185.PubMed

82.

Smith CD, Stival A, Howell DL, Swafford V. Endoscopic therapy for achalasia before Heller myotomy results in worse outcomes than heller myotomy alone. Ann Surg 2006;243:579–584. discussion 584–576.PubMed

83.

Zanardi F, Tempini GB. Stenosis of the cardia and esophageal achalasia; a case treated with total cardioplasty. Minerva Chir 1952;7:293–297.PubMed

84.

Heller E. Extramukose Cardioplastik beim chronischen Cardiospasmus mit Dilatation des Osophagus. Mitteil Grengeb Med Chir 1914;2:141–149.

85.

Zaaijer JH. Cardiospasm in the aged. Ann Surg 1923;77:615–617.PubMed

86.

Tomlinson P, Grant AF. A review of 74 patients with oesophageal achalasia: the results of Heller's cardiomyotomy, with and without Nissen fundoplication. Aust N Z J Surg 1981;51:48–51.PubMed

87.

Pellegrini C, Wetter LA, Patti M, Leichter R, Mussan G, Mori T, Bernstein G, Way LW. Thoracoscopic esophagomyotomy. Initial experience with a new approach for the treatment of achalasia. Ann Surg 1992;216:291–296. discussion 296–299.PubMed

88.

Rosati R, Fumagalli U, Bonavina L, Segalin A, Montorsi M, Bona S, Peracchia A. Laparoscopic approach to esophageal achalasia. Am J Surg 1995;169:424–427.PubMed

89.

Shimi S, Nathanson LK, Cuschieri A. Laparoscopic cardiomyotomy for achalasia. J R Coll Surg Edinb 1991;36:152–154.PubMed

90.

Codispoti M, Soon SY, Pugh G, Walker WS. Clinical results of thoracoscopic Heller's myotomy in the treatment of achalasia. Eur J Cardiothorac Surg 2003;24:620–624.PubMed

91.

Lee JM, Wang CH, Huang PM, Hsu HH, Chen JS, Lee CJ, Lee YC. Enduring effects of thoracoscopic Heller myotomy for treating achalasia. World J Surg 2004;28:55–58.PubMed

92.

Torquati A, Richards WO, Holzman MD, Kennneth W. Laparoscopic myotomy for achalasia. Predictors of successful outcome after 200 cases. Ann Surg 2006;243:587–593.PubMed

93.

Arain MA, Peters JH, Tmhankar AP, Portale G, Almogy G, DeMeester SR, Crookes PF, Hagen JA, Bremner CG, DeMeester TR. Preoperative lower esophageal sphincter pressure affects outcome of laparoscopic esophageal myotomy for achalasia. J Gastrointest Surg 2004;8:328–334.PubMed

94.

Zaninotto G, Costantini M, Rizzett C, Zanatta Z, Guirroli E, Portale G, Nicoletti L, Battaglia G, Ruol A, Ancona E. Four hundred laparoscopic myotomies for esophageal achalasia, a single center experience. Ann Surg 2008;248:986–993.PubMed

95.

Lyass S, Thoman D, Steiner JP, Phillips E. Current status of an antireflux procedure in laparoscopic Heller myotomy. Surg Endosc 2003;17:554–558.PubMed

96.

Avtan L, Avci C, Guvenc H, Igci A, Ozmen V. Laparoscopic myotomy for oesophageal achalasia—adding an antireflux procedure is not always necessary. Int J Clin Pract 2005;59:35–38.PubMed

97.

Ramacciato G, D'Angelo FA, Aurello P, Del Gaudio M, Varotti G, Mercantini P, Bellagamba R, Ercolani G. Laparoscopic Heller myotomy with or without partial fundoplication: a matter of debate. World J Gastroenterol 2005;11:1558–1561.PubMed

98.

Rebecchi F, Giaccone C, Farinella E, Campaci R, Morino M. Randomized controlled trial of laparoscopic Heller myotomy plus Dor fundoplication versus Nissen fundoplication for achalasia long-term results. Ann Surg 2008;248:1023–1030.PubMed

99.

Society for Surgery of the Alimentary Tract. Esophageal achalasia. SSAT patient care guidelines. J Gastrointest Surg 2004;8:367–368.

100.

Campos GM, Ciovica R, Takata M. Laparoscopic myotomy. Oper Tech Gen Surg 2006;8:161–169.

101.

Urbach DR, Hansen PD, Khajanchee YS, Swanstrom LL. A decision analysis of the optimal initial approach to achalasia: laparoscopic Heller myotomy with partial fundoplication, thoracoscopic Heller myotomy, pneumatic dilatation, or botulinum toxin injection. J Gastrointest Surg 2001;5:192–205.PubMed

102.

Topart P, Deschamps C, Taillefer R, Duranceau A. Long-term effect of total fundoplication on the myotomized esophagus. Ann Thorac Surg 1992;54:1046–1051. discussion 1051–1042.PubMedCrossRef

103.

Falkenback D, Johansson J, Oberg S, Kjellin A, Wenner J, Zilling T, Johnsson F, Von Holstein CS, Walther B. Heller's esophagomyotomy with or without a 360 degrees floppy Nissen fundoplication for achalasia. Long-term results from a prospective randomized study. Dis Esophagus 2003;16:284–290.PubMed

104.

Richards WO, Torquati A, Holzman MD, Khaitan L, Byrne D, Lutfi R, Sharp KW. Heller myotomy versus Heller myotomy with Dor fundoplication for achalasia: a prospective randomized double-blind clinical trial. Ann Surg 2004;240:405–412. discussion 412–405.PubMed

105.

Wills VL, Hunt DR. Functional outcome after Heller myotomy and fundoplication for achalasia. J Gastrointest Surg 2001;5:408–413.PubMed

106.

Jamieson WR, Miyagishima RT, Carr DM, Stordy SN, Sharp FR. Surgical management of primary motor disorders of the esophagus. Am J Surg 1984;148:36–42.PubMed

107.

Stipa S, Fegiz G, Iascone C, Paolini A, Moraldi A, De Marchi C, Chieco PA. Heller–Belsey and Heller–Nissen operations for achalasia of the esophagus. Surg Gynecol Obstet 1990;170:212–216.PubMed

108.

Limpert PA, Naunheim KS. Partial versus complete fundoplication: is there a correct answer? Surg Clin North Am 2005;85:399–410.PubMed

109.

Perrone JM, Frisella MM, Desai KM, Soper NJ. Results of laparoscopic Heller–Toupet operation for achalasia. Surg Endosc 2004;18:1565–1571.PubMed

110.

Dobashi Y, Goseki N, Inutake Y, Kawano T, Endou M, Nemoto T. Giant epiphrenic diverticulum with achalasia occurring 20 years after Heller's operation. J Gastroenterol 1996;31:844–847.PubMed

111.

Raiser F, Perdikis G, Hinder RA, Swanstrom LL, Filipi CJJ, McBride PJ, Katada N, Neary PJ. Heller myotomy via minimal-access surgery. An evaluation of antireflux procedures. Arch Surg 1996;131:593–597. discussion 597–598.PubMed

112.

Ware J, Snow K, Kosinski M, Gandek B. SF-36 health survey: manual and intrepretation guide. Boston: The Health Institute, New England Medical Center, 1993.

113.

Gaissert HA, Lin N, Wain JC, Frankhauser G, Wright CD, MMathisen DJ. Transthoracic Heller myotomy for esophageal achalasia: analysis of long-term results. Ann Thorac Surg 2006;81:2044–2049.PubMed

114.

Mineo TC, Pompeo E. Long-term outcome of Heller myotomy in achalasic sigmoid esophagus. J Thorac Cardiovasc Surg 2004;128:402–407.PubMed

115.

Sweet MP, Nipomnick I, Gasper WJ, Bagatelos K, Ostroff JW, Fisichella PM, Way LW, Patti MG. The outcome of laparoscopic Heller myotomy for achalasia is not influenced by the degree of esophageal dilatation. J Gastrointest Surg 2008;12:159–165.PubMed

116.

Gelfond M, Rozen P, Keren S, Gilat T. Effect of nitrates on LOS pressure in achalasia: a potential therapeutic aid. Gut 1981;22:312–318.PubMed

117.

Rozen P, Gelfond M, Salzman S, Baron J, Gilat T. Radionuclide confirmation of the therapeutic value of isosorbide dinitrate in relieving the dysphagia in achalasia. J Clin Gastroenterol 1982;4:17–22.PubMedCrossRef

118.

Bortolotti M, Labo G. Clinical and manometric effects of nifedipine in patients with esophageal achalasia. Gastroenterology 1981;80:39–44.PubMed

119.

Traube M, Dubovik S, Lange RC, McCallum RW. The role of nifedipine therapy in achalasia: results of a randomized, double-blind, placebo-controlled study. Am J Gastroenterol 1989;84:1259–1262.PubMed

120.

Traube M, Hongo M, Magyar L, McCallum RW. Effects of nifedipine in achalasia and in patients with high-amplitude peristaltic esophageal contractions. Jama 1984;252:1733–1736.PubMed

121.

Coccia G, Bortolotti M, Michetti P, Dodero M. Prospective clinical and manometric study comparing pneumatic dilatation and sublingual nifedipine in the treatment of oesophageal achalasia. Gut 1991;32:604–606.PubMed

122.

Gelfond M, Rozen P, Gilat T. Isosorbide dinitrate and nifedipine treatment of achalasia: a clinical, manometric and radionuclide evaluation. Gastroenterology 1982;83:963–969.PubMed

123.

Bortolotti M, Coccia G, Brunelli F, Sarti P, Mazza M, Bagnato F, Barbara L. Isosorbide dinitrate or nifedipine: which is preferable in the medical therapy of achalasia? Ital J Gastroenterol 1994;26:379–382.PubMed

Title: A Controversy That Has Been Tough to Swallow: Is the Treatment of Achalasia Now Digested?
Authors: Garrett R. Roll
Charlotte Rabl
Ruxandra Ciovica
Sofia Peeva
Guilherme M. Campos
Publication date: 01-02-2010
Publisher: Springer-Verlag
Published in: Journal of Gastrointestinal Surgery / Issue Special Issue 1/2010
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-009-1013-5

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

A Controversy That Has Been Tough to Swallow: Is the Treatment of Achalasia Now Digested?

Abstract

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Special Issue 1/2010

Future Applications of Flexible Endoscopy in Esophageal Surgery

Genetics in the Pathogenesis of Esophageal Cancer: Possible Predictive and Prognostic Factors

Initial Experience with New Intraluminal Devices for GERD Barrett’s Esophagus and Obesity

Minimally Invasive Esophagectomy

Is Esophagectomy the Paradigm for Volume–Outcome Relationships?

The Molecular Pathogenesis of Barrett’s Esophagus: Common Signaling Pathways in Embryogenesis Metaplasia and Neoplasia