Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India.
Department of Digestive Diseases and Endoscopy, Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra, India.
J Gastroenterol Hepatol. 2018 Aug;33(8):1436-1444. doi: 10.1111/jgh.14097.
Achalasia cardia (AC) is a frequently encountered motility disorder of the esophagus resulting from an irreversible degeneration of neurons. Treatment modalities are palliative in nature, and there is no curative treatment available for AC as of now. Significant advancements have been made in the management of AC over last decade. The introduction of high resolution manometry and per-oral endoscopic myotomy (POEM) has strengthened the diagnostic and therapeutic armamentarium of AC. High resolution manometry allows for the characterization of the type of achalasia, which in turn has important therapeutic implications. The endoscopic management of AC has been reinforced with the introduction of POEM that has been found to be highly effective and safe in palliating the symptoms in short-term to mid-term follow-up studies. POEM is less invasive than Heller's myotomy and provides the endoscopist with the opportunity of adjusting the length and orientation of esophageal myotomy according to the type of AC. The management of achalasia needs to be tailored for each patient, and the role of pneumatic balloon dilatation, POEM, or Heller's myotomy needs to be revisited. In this review, we discuss the important aspects of diagnosis as well as management of AC. The statements presented in the manuscript reflect the cumulative efforts of an expert consensus group.
贲门失弛缓症（AC）是一种常见的食管动力障碍性疾病，其特征为神经元的不可逆退行性变。目前，AC 的治疗方法主要是姑息性的，尚无根治方法。在过去十年中，AC 的治疗取得了显著进展。高分辨率测压和经口内镜肌切开术（POEM）的应用，增强了 AC 的诊断和治疗手段。高分辨率测压可以对 AC 的类型进行特征描述，这对治疗具有重要意义。POEM 的引入进一步加强了 AC 的内镜治疗，在短期至中期随访研究中，POEM 被发现对缓解症状非常有效且安全。POEM 比 Heller 肌切开术更具微创性，为内镜医生提供了根据 AC 的类型调整食管肌切开术的长度和方向的机会。AC 的管理需要针对每个患者进行个体化，需要重新评估气囊扩张、POEM 或 Heller 肌切开术的作用。在这篇综述中，我们讨论了 AC 的诊断和管理的重要方面。本文献中的陈述反映了专家组的集体努力。
