| Theme |
Digestive Diseases to Know -- Esophagus |
| Title |
Esphogeal Achalasia : Considerations from the Medical Aspect |
| Author |
Masami Yamada |
Department of Gastroenterology, Hamamatsu Medical Center |
| Author |
Eizo Kaneko |
First Department of Medicine, Hamamatsu University School of Medicine |
| [ Summary ] |
Achalasia is the best known primary motility disorder of the esophagus. The etiology of achalasia is still unknown, but the defect in intrinsic and extrinsic innervation is well established. The results of pharmacological studies suggest that the inhibitory non-adrenergic, non-cholinergic fibers of the vagus nerve are involved. The treatment aims at reducing the lower esophageal sphincter (LES) pressure and at curing defecting relaxation. Some pharmacological agents act on LES pressure and are beneficial for short-term relief in patients with relatively mild symptoms or as a temporary measures before a more definitive form of therapy. Balloon dilatation is a safe and effective treatment, and should be the initial treatment for all patients with achalasia. Endoscopic injection of botulinum toxin or ethanolamine has recently been proposed as an alternative to pneumatic dilatation or surgery. However, their long term efficacy still needs to be further studied with randomized controlled trials. Longstanding achalasia has been suggested as a predisposing risk factor for the development of esophageal cancer. |