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Curr Opin Anaesthesiol 2019 Apr 15. Epub 2019 Apr 15.

Department of Anesthesiology, Nagasaki University School of Medicine, Nagasaki, Japan.

Purpose Of Review: Peroral endoscopic myotomy (POEM) was developed in Japan as a less invasive treatment for esophageal achalasia requiring general anesthesia under positive pressure ventilation. In 2018, the Japan Gastroenterological Endoscopy Society published the first guidelines describing the standard care for POEM. Based on these guidelines, we discuss the typical approach to anesthesia during POEM for the management of esophageal achalasia in Japan. Read More

Neurogastroenterol Motil 2019 Apr 17:e13601. Epub 2019 Apr 17.

Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, Wisconsin.

Background: Opioid receptors are present in the esophagus, and chronic opioid therapy may be associated with esophageal dysfunction. Given the current opioid epidemic in the United States, the potential contribution of opioids to esophageal dysmotility is important from both public health and patient care perspectives. Therefore our aim is to investigate the potential contribution of opioids to dysphagia and the prevalence of major motor disorders in patients undergoing manometric evaluation. Read More

J Neurogastroenterol Motil 2019 Apr;25(2):205-211

Division of Gastroenterology and Hepatology, University Hospital Zurich, Switzerland.

Background/aims: The influence of external factors such as opioids and alcohol has been extensively investigated for various segments of the gastrointestinal tract. However, the association between their use and the development of esophagogastric junction outflow obstruction disorders (EGJOODs) is unknown. Therefore, the aim of this study is to analyze prevalence and clinical relevance of opioids and alcohol intake in patients with EGJOODs. Read More

J Neurogastroenterol Motil 2019 Apr;25(2):177-178

Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Asan Digestive Disease Research Institute, Seoul, Korea.

Dis Esophagus 2019 Apr 12. Epub 2019 Apr 12.

Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, and.

Although treatment for esophageal motility disorder improves dysphagia and increases body weight, the effect of the treatment on body composition is unclear. This study aimed to assess the change in body composition between before and after treatment, the preoperative predictors of muscle increase, and the association between muscle increase and quality of life. Sixty-one patients (achalasia, n = 55; spastic esophageal disorder n = 6) who underwent per-oral endoscopic myotomy were analyzed in a single-arm prospective observational study. Read More

Zentralbl Chir 2019 Apr 12;144(2):163-170. Epub 2019 Apr 12.

Universitätsklinik für Chirurgie, Salzburger Landeskliniken, Salzburg, Österreich.

Treatment of primary idopathic achalasia, the most common of the rare oesophageal motility disorders, is currently changing. The therapeutic priciple of Heller's myotomy is increasingly accepted as standard. In 1913, the German surgeon Ernst Heller described the cardiomyotomy named after him, faciliating excellent symptom control. Read More

Neurogastroenterol Motil 2019 May 11;31(5):e13587. Epub 2019 Apr 11.

CHU Bordeaux, Gastroenterology, Université de Bordeaux, Bordeaux, France.

Introduction: Botulinum toxin injection is known to be efficient to treat achalasia. We conducted a randomized trial in order to evaluate its efficacy to treat symptomatic hypercontractile esophageal disorders as characterized by esophageal high-resolution manometry.

Methods: Patients with significant dysphagia and/or thoracic pain related to an hypercontractile esophageal motility disorder as defined by the Chicago Classification were randomized to receive an injection of botulinum toxin (100 U in 10 points in the distal part of the esophageal wall) or a sham procedure. Read More

J Vet Intern Med 2019 Apr 9. Epub 2019 Apr 9.

Department of Veterinary Medicine and Surgery, University of Missouri, Columbia, Missouri.

Background: Megaesophagus (ME) carries a poor long-term prognosis in dogs. In people, lower esophageal sphincter (LES) achalasia is a rare cause of ME that may respond to targeted intervention. Dogs with lower esophageal sphincter achalasia-like syndrome (LES-AS) have been described recently, warranting investigation of analogous targeted treatment. Read More

Neurogastroenterol Motil 2019 Apr 7:e13586. Epub 2019 Apr 7.

GI Physiology Unit, University College London Hospital, London, UK.

Background: Achalasia diagnosis requires elevated integrated relaxation pressure (IRP; manometric marker of lower esophageal sphincter [LES] relaxation). Yet, some patients exhibit clinical features of achalasia despite normal IRP and have LES dysfunction demonstrable by other means. We hypothesized these patients to exhibit equivalent therapeutic response compared to standard achalasia patients. Read More

Clin Res Hepatol Gastroenterol 2019 Apr 4. Epub 2019 Apr 4.

Gastroenterology department, Rouen University Hospital, 76031 Rouen cedex, France; Digestive tract environment and nutrition Inserm Unit U1073, Rouen university, 76031 Rouen cedex, France.

World J Gastroenterol 2019 Mar;25(12):1457-1464

Division of Gastroenterology, Niigata University Medical and Dental Hospital, Niigata 951-8510, Japan.

Esophageal diverticula are rare conditions that cause esophageal symptoms, such as dysphagia, regurgitation, and chest pain. They are classified according to their location and characteristic pathophysiology into three types: epiphrenic diverticulum, Zenker's diverticulum, and Rokitansky diverticulum. The former two disorders take the form of protrusions, and symptomatic cases require interventional treatment. Read More

Am Surg 2019 Mar;85(3):e162-e163

J Dig Dis 2019 Mar 27. Epub 2019 Mar 27.

Department of Gastroenterology, West China Hospital, Sichuan University, China, NO. 37, Guo Xue Xiang, Chengdu, Sichuan, China. 610041.

After the introduction of per-oral endoscopic myotomy(POEM) which was initially carried out in humans with achalasia by Inoue et al. in 2010, POEM has become an established treatment for achalasia due to its high feasibility and effectiveness. This article is protected by copyright. Read More

J Family Med Prim Care 2019 Jan;8(1):289-297

Department of Gastroenterology, Naval Medical Center, San Diego, Bob Wilson Drive, San Diego, California, United States.

We present the case of a 28-year-old female who presented for primary care at 22-week gestation with type II achalasia and worsening solid/liquid dysphagia leading to pregnancy weight loss. Considering that durable therapies such as surgical myotomy and pneumatic dilatation have considerable risk, botulinum A toxin injection was selected as a temporizing bridging therapy. She had an uncomplicated post procedure course and had significant rapid improvement in dysphagia symptoms, which enabled her to progress to normal peripartum weight. Read More

J Laparoendosc Adv Surg Tech A 2019 Mar 20. Epub 2019 Mar 20.

Department of Surgical, Oncological and Gastroenterological Sciences, School of Medicine, University of Padova, Padova, Italy.

Background: Achalasia is currently classified in three manometric patterns. Pattern III is the least common pattern, and reportedly correlated with the worst outcome after all available treatments. We aimed to investigate the final outcome in pattern III achalasia patients after classic laparoscopic myotomy (CLM) as compared with a myotomy lengthened both downward and upward (long laparoscopic myotomy [LLM]). Read More

Endoscopy 2019 Apr 18;51(4):397. Epub 2019 Mar 18.

Biomed Res Int 2019 6;2019:8549187. Epub 2019 Feb 6.

Gastrointestinal Motility Unit, Division of Gastroenterology, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, 833 Kaohsiung, Taiwan.

Over the past few decades, there was an encouraging breakthrough in bridging the gap between advancements in the evolution of diagnosis and treatment towards a better outcome in achalasia. The purpose of this review is to provide updated knowledge on how the current evidence has bridged the gap between advancements in the evolution of diagnosis and treatment of esophageal achalasia. The advent of high-resolution manometry and standardization based on the Chicago classification has increased early recognition of the disease. Read More

Clin Res Hepatol Gastroenterol 2019 Mar 14. Epub 2019 Mar 14.

Department of gastroenterology, Cochin Hospital, assistance publique-Hôpitaux de Paris, Paris, France; Paris Descartes University, Paris, France.

Introduction: Endoscopic ultrasonography (EUS) is advised in the workup of achalasia patients to rule out secondary achalasia or pseudoachalasia, and search for a typical esophageal wall thickening. The purpose of this study was to assess the clinical contribution of EUS findings in achalasia and other esophageal motility disorders (EMD).

Methods: We conducted a single center retrospective study at a tertiary referral centre. Read More

Tech Gastrointest Endosc 2018 Jul 18;20(3):114-119. Epub 2018 Aug 18.

Department of Surgery, Northwestern University Feinberg School of Medicine, 676 North Saint Clair Street, Suite 650, Chicago, Illinois, 60611.

Achalasia is a rare esophageal motility disorder that necessitates the disruption of the lower esophageal sphincter. Patients with achalasia should be evaluated in a systematic, multidisciplinary fashion. Workup should include upper endoscopy, esophagography, and high-resolution manometry. Read More

Neurogastroenterol Motil 2019 May 13;31(5):e13565. Epub 2019 Mar 13.

Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China.

Background: Achalasia is a motility disorder of unknown etiology. Previous studies supported the hypothesis that autoimmune-mediated inflammatory responses produce inhibitory neuronal degeneration. This study was designed to explore the role of mast cells in achalasia. Read More

Korean J Intern Med 2019 Mar 15. Epub 2019 Mar 15.

Division of Surgery, Oregon Health Sciences University, Portland, OR, USA.

Achalasia was first described in the 17th century and its treatment continues to be challenging. Palliative treatment involves disruption of the lower esophageal sphincter, which can be accomplished mechanically (balloon dilation or surgical myotomy) or chemically (Botox). True surgical treatment originated some 100 years ago and remained largely unchanged until the advent of thoracoscopic and then laparoscopic myotomy beginning in the 1980s. Read More

Z Gastroenterol 2019 Mar 12;57(3):304-311. Epub 2019 Mar 12.

Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin City, China.

Background And Aims:  On the basis of lesser rates of major adverse events and a short-term efficacy as Heller's myotomy, there is a growing enthusiasm in favor of peroral endoscopic myotomy (POEM), whereas study comparing POEM and pneumatic dilatation (PD) is quite rare. The aim of this study was to evaluate the efficacy of POEM and PD in Chinese achalasia patients in a retrospectively designed study.

Methods:  Patients with achalasia, who underwent either PD (n = 26) or POEM (n = 40) were retrospectively recruited from September 2010 through March 2016 at a single tertiary center. Read More

Khirurgiia (Mosk) 2019(2):72-77

Sklifosovsky Research Institute for Emergency Medicine of Moscow Healthcare Department, Moscow, Russia.

Prevalence, clinical manifestations and of modern classifications of achalasia are reviewed in the article. Diagnosis and treatment of this pathology were analyzed by using of 58 references. Read More

J Gastrointestin Liver Dis 2019 Mar;28(1):107-115

Digestive Diseases Center, Showa University, Koto-Toyosu Hospital, Tokyo, Japan.

Background And Aims: The optimal orientation of the myotomy during peroral endoscopic myotomy (POEM) is unknown. This meta-analysis aims to compare anterior and posterior myotomy regarding clinical success and safety.

Methods: PubMed, Embase, Cochrane Library, WOK, and clinicaltrials. Read More

J Gastrointestin Liver Dis 2019 Mar;28(1)

Gastroenterology Unit, Department of Medical and Surgical Sciences, University of Bologna, Italy.

Korean J Gastroenterol 2019 Feb;73(2):105-108

Division of Gastroenterology and Hepatology, SBH Health System, Bronx, NY, USA.

Achalasia is a motility disorder of the esophagus that is characterized by loss of ganglionic neurons within the myenteric plexus of the lower esophageal sphincter (LES) resulting in failure of the LES to relax. Clinically this disorder presents with simultaneous dysphagia to solids and liquids, and if left untreated, leads to esophageal dilation, which can give rise to many adverse consequences. Extrinsic compression of respiratory structures is one such consequence, and rarely, cases of tracheal compression secondary to achalasia have been reported. Read More

World J Gastrointest Surg 2019 Feb;11(2):112-116

Division of Gastrointestinal Surgery and Liver Transplantation, Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre 90035-903, Brazil.

Background: Esophagogastric junction outflow obstruction (EGJOO) is a rare syndrome, characterized by an elevation of the integrated relaxation pressure of the lower esophageal sphincter, not accompanied by alterations in esophageal motility that may lead to the criteria for achalasia. We were unable to find any prior report of the combination of Heller myotomy with anterior partial fundoplication (Dor) as the treatment for EGJOO. We herein report a case of EGJOO treated with laparoscopic Heller myotomy combined with Dor fundoplication. Read More

J Steroid Biochem Mol Biol 2019 Feb 25;189:73-80. Epub 2019 Feb 25.

Centre for Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary, University of London, Charterhouse Square, London, United Kingdom. Electronic address:

Hereditary adrenocorticotropin (ACTH) resistance syndromes encompass the genetically heterogeneous isolated or Familial Glucocorticoid Deficiency (FGD) and the distinct clinical entity known as Triple A syndrome. The molecular basis of adrenal resistance to ACTH includes defects in ligand binding, MC2R/MRAP receptor trafficking, cellular redox balance, cholesterol synthesis and sphingolipid metabolism. Biochemically, this manifests as ACTH excess in the setting of hypocortisolaemia. Read More

Neurogastroenterol Motil 2019 May 27;31(5):e13558. Epub 2019 Feb 27.

Division of Gastroenterology, Washington University School of Medicine, Saint Louis, Missouri.

Background: Upper esophageal sphincter (UES) metrics on high-resolution manometry (HRM), particularly nadir UES residual pressure (UES-RP), are abnormal in achalasia and may help characterize the underlying mechanism or predict management outcome in esophagogastric junction outflow obstruction (EGJOO).

Methods: A database of consecutive patients undergoing esophageal HRM from 2008 to 2013 yielded 134 patients (59.8 ± 1. Read More

Rinsho Shinkeigaku 2019 Mar 28;59(3):149-152. Epub 2019 Feb 28.

Department of Internal Medicine, Imari Arita Kyoritsu Hospital.

A 73-year-old woman with Parkinson disease (PD) was admitted to our hospital because of aspiration pneumonia. She presented with recurrent episodes of loss of consciousness with bradycardia while swallowing solid foods or fluids. Upper endoscopy revealed a normal esophagus without hiatus hernia, cancer, diverticulum, stenosis, or achalasia. Read More

J Pediatr Surg 2019 Feb 12. Epub 2019 Feb 12.

Unit of Pediatric Surgery, Giannina Gaslini Institute, Genoa, Italy.

Introduction: The association of Hirschsprung disease (HSCR) and Down Syndrome (DS) is not uncommon (HSCR+DS). This paper aims at reporting the results of a 24-year series focusing on surgical approach, complications and long term outcome.

Materials And Methods: The notes of all patients admitted with a diagnosis of HSCR+DS have been retrospectively reviewed. Read More

Dis Esophagus 2019 Feb 27. Epub 2019 Feb 27.

Department Surgery & Cancer, Imperial College London, London.

The objective of this study is to identify the incidence of and risk factors associated with the development of esophageal cancer in treated achalasia patients in a national cohort. Patients with esophageal achalasia diagnosed and receiving a treatment between 2002 and 2012 were identified in England. Patient and treatment factors were compared between individuals who developed esophageal cancer and those that did not using univariate and multivariate analyses. Read More

J Pediatr Surg 2019 Feb 5. Epub 2019 Feb 5.

Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX.

Background: High-resolution esophageal manometry (HREM) during laparoscopic Heller myotomy (LHM) with fundoplication for achalasia allows tailoring of myotomy length and wrap tightness. The purpose of this study is to quantify long-term postoperative symptom severity and quality of life using validated questionnaires.

Methods: Children ≤18 years with achalasia who previously underwent LHM with intraoperative HREM from 2010 to 2017 were prospectively surveyed. Read More

Dig Dis Sci 2019 Feb 25. Epub 2019 Feb 25.

Gastroenterology Section, Department of Medicine, Lewis Katz School of Medicine at Temple University, 3401 North Broad Street, Philadelphia, PA, 19140, USA.

Background: Multiple rapid swallows (MRS) during HREM assess post-deglutitive inhibition, LES relaxation, and subsequent esophageal contraction.

Aims: (1) To determine the relationship between MRS and single-swallow (SS) responses and (2) to determine if MRS provides information for symptomatic patients.

Methods: Healthy volunteers (HVs) and patients underwent HREM [30-s landmark, ten 5-mL SS, MRS (5 consecutive 2-mL swallows every 2-3 s)] and were analyzed with ManoView software version 3 with CC version 3. Read More

United European Gastroenterol J 2019 Feb 3;7(1):45-51. Epub 2018 Oct 3.

Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.

Background: Achalasia is a primary oesophageal motility disorder. Although aetiology remains mainly unknown, a genetic risk variant, rs28688207 in HLA-DQB1, showed strong achalasia association suggesting involvement of immune-mediated processes in the pathogenesis. High-resolution manometry recognises three types of achalasia. Read More

Indian J Gastroenterol 2019 Feb 19. Epub 2019 Feb 19.

Department of Gastroenterology, Gleneagles Global Health City, Chennai 600 101, India.

Obes Surg 2019 Feb 18. Epub 2019 Feb 18.

Department of Biomedical Science for Health, Division of General Surgery, Istitituto Clinico Sant'Ambrogio, University of Milan, Milan, Italy.

Introduction: The development of achalasia after Roux-en-Y gastric bypass (RYGB) is rare. Heller myotomy (HM) is the gold standard treatment while peroral endoscopic myotomy (POEM) is an emerging technique with promising results. The aim of this narrative review was to summarize the current knowledge on the treatment of esophageal achalasia after RYGB. Read More

Curr Probl Surg 2019 Feb;56(2):91

Center of Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill, NC.

Ann R Coll Surg Engl 2019 Apr 18;101(4):256-260. Epub 2019 Feb 18.

Zen Hospital , Mumbai , India.

Introduction: Epiphrenic diverticulum (ED) is an uncommon disease that is invariably associated with an underlying oesophageal motility disorder such as achalasia. Management of ED should always be accompanied by treatment of the underlying motility disorder to prevent recurrence of symptoms. Traditionally, ED were approached via a left thoracotomy but as laparoscopy offers better access to the distal oesophagus, its use is becoming more widespread. Read More

Esophagus 2019 Feb 15. Epub 2019 Feb 15.

Department of Gastroenterological Surgery, Osaka University, Graduate School of Medicine, 2-2, E-2, Yamadaoka, Suita, Osaka, 565-0871, Japan.

Background: The fourth edition of New Japanese classification system for esophageal achalasia was revised after a long interval of 30 years in 2012. In this new system, achalasia is morphologically classified into 3 types, based on its X-ray findings. However, the system has been limitedly used in Japan and has not been fully validated in terms of its predictive capability of postoperative outcomes. Read More

Surg Endosc 2019 Feb 14. Epub 2019 Feb 14.

Centre for Minimal Access Surgery (CMAS), Division of General Surgery, Department of Surgery, McMaster University St. Joseph's Healthcare, 50 Charlton Avenue East Hamilton, Hamilton, ON, L8N 4A6, Canada.

Background: Achalasia is a rare primary esophageal dysmotility disorder in children. Peroral endoscopic myotomy (POEM) is a novel endoscopic technique which has shown promising results for treating achalasia in adults. However, limited data on efficacy and safety in pediatric patients are available. Read More

VideoGIE 2019 Feb 13;4(2):68-71. Epub 2018 Nov 13.

Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.

VideoGIE 2019 Feb 11;4(2):62-65. Epub 2018 Dec 11.

Department of Gastroenterology, Evangelisches Krankenhaus Düsseldorf, Düsseldorf, Germany.

Chirurg 2019 Mar;90(Suppl 2):20

Klinik für Allgemein‑, Viszeral- und Tumorchirurgie, Universitätsklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland.

World J Surg 2019 Feb 12. Epub 2019 Feb 12.

Mayne Medical School, School of Medicine, University of Queensland, Brisbane, QLD, Australia.

Background And Aims: Partial fundoplication is commonly performed in conjunction with Heller Myotomy. It is, however, controversial whether anterior Dor or posterior Toupet partial fundoplication is the antireflux procedure of choice. The aim was to perform a systematic review and meta-analysis of studies comparing these two procedures. Read More

Z Gastroenterol 2019 Feb 12;57(2):151-155. Epub 2019 Feb 12.

Medizinische Klinik II, HELIOS Klinikum Krefeld, Germany.

Background:  Eosinophilic esophagitis (EoE) is detected frequently in dysphagia and noncardiac chest pain. Management of patients with EoE may be complicated because EoE is associated frequently with esophageal motility disorders. We present the rare case of esophageal achalasia (EA) associated with eosinophilic infiltration and a literature review. Read More

Am Surg 2018 Nov;84(11):1796-1800

Pneumatic balloon dilatation (BD) and laparoscopic Heller's myotomy (LHM) are usually preferred treatment options for relieving dysphagia symptoms in achalasia. The aim of the present study was to describe a new technical method for a safe and effective LHM. Endoscopic BD tube (Rigiflex 30-mm pneumatic balloon) is simultaneously insufflated and desufflated in the esophagus during LHM to assess myotomy in 50 consecutive patients. Read More

An Pediatr (Barc) 2019 Feb 7. Epub 2019 Feb 7.

Unidad Pediátrica, Servicio de Otorrinolaringología, Complejo Hospitalario Universitario A Coruña, A Coruña, España.

BMC Gastroenterol 2019 Feb 11;19(1):28. Epub 2019 Feb 11.

University of South Florida, Division of Gastroenterology, Florida, USA.

An elevation of serum inflammatory biomarkers in achalasia patients compared with controls recently was demonstrated. It has not been determined whether the elevation of inflammatory cytokines is unique to achalasia or occurs with other diseases involving the esophagus. The primary aim of our study was to compare the differences in plasma immunological profiles (TNF- α receptor, IL-6, IFN-γ, IL-12, IL-17, IL-22, and IL-23) of patients with achalasia, eosinophilic esophagitis (EoE), and gastroesophageal reflux disease (GERD). Read More

Am J Gastroenterol 2019 Feb 5. Epub 2019 Feb 5.

Division of Gastroenterology and Hepatology, Northwestern Medicine, Chicago, Illinois, USA.

Introduction: To compare the utility of the distensibility index (DI) on functional lumen imaging probe (FLIP) topography to other esophagogastric junction (EGJ) metrics in assessing treatment response in achalasia in the context of esophageal anatomy.

Methods: We prospectively evaluated 79 patients (at ages 17-81 years; 47% female patients) with achalasia during follow-up after pneumatic dilation, Heller myotomy, or per-oral endoscopic myotomy with timed barium esophagram, high-resolution impedance manometry, and FLIP. Anatomic deformities were identified based on consensus expert opinion. Read More