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Dig Dis Sci 2022 May 21. Epub 2022 May 21.

Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, 55905, USA.

Background: Residual food (RF) during esophagogastroduodenoscopy (EGD) is thought, but not proven, to be a risk factor for gastric-to-pulmonary aspiration.

Aims: The aims of this study were to determine the prevalence of RF during EGD, to investigate whether RF was associated with an increased risk of aspiration, especially when monitored anesthesia care (MAC) or general anesthesia (GA) were administered, and to determine whether aspiration associated with RF led to a more severe clinical outcome.

Methods: Patients undergoing EGD between October 2012 and September 2018 were identified. Read More

VideoGIE 2022 May 14;7(5):175-177. Epub 2022 Mar 14.

Department of Gastroenterology and Hepatology, Humanitas Research Hospital IRCCS, Rozzano, Italy.

Video 1At preoperative esophagram, a typical bird's beak image is shown at the gastroesophageal junction. A gastro-gastric fistula, opening from cardia to fundus, is also shown. A scope fitted with a distal clear cap is introduced. Read More

BMC Gastroenterol 2022 May 18;22(1):253. Epub 2022 May 18.

Department of Gastroenterology, The Seventh Medical Center of PLA General Hospital, Nanmencang 5#, Dongcheng District, Beijing, 100700, China.

Background: Achalasia is a rare primary esophageal motility disorder disease. It is reported that the long-term effect of fully coated anti-reflux metal stent (FCARMS) implantation is satisfactory. Operated by a skilled and experienced endoscopist, the effect of per-oral endoscopic myotomy (POEM) treatment is equivalent to that of surgical myotomy. Read More

Dysphagia 2022 May 18. Epub 2022 May 18.

Division of Gastroenterology and Nutrition, Morsani College of Medicine, University of South Florida, 12901 Bruce B. Downs Blvd, MDC 72, Tampa, FL, 33612, USA.

Achalasia is a rare disease of the esophagus with impaired relaxation of the lower esophageal sphincter and aperistalsis. The etiology is unknown but speculations include a viral or autoimmune etiology. All specialists dealing with swallowing and esophageal diseases should recognize the classic symptoms of dysphagia for solids/liquids, regurgitation, and choking, especially at night. Read More

Langenbecks Arch Surg 2022 May 18. Epub 2022 May 18.

Division of General, Minimally Invasive and Robotic Surgery, University of Illinois at Chicago, 840 S Wood Street, Suite 435 E, Clinical Sciences Building, Chicago, IL, 60612, USA.

Background: Despite the high success rate associated with Heller myotomy in the treatment of primary achalasia, symptom persistence or relapse occurs in approximately 10-20% of patients. Unfortunately, the ideal treatment after failed myotomy is not well established yet. We present a didactical video with a stepwise technique to perform a robotic revisional procedure after failed Heller myotomy. Read More

Am Surg 2022 May 17:31348221080418. Epub 2022 May 17.

Department of Surgery, RinggoldID:21693University of Mississippi, Jackson, MS, USA.

We hypothesize that obesity is a common diagnosis in those with achalasia at our institution but time to diagnosis and treatment is longer compared to normal weight counterparts due to implicit bias. We retrospectively reviewed all adult patients between 1/1/2013 and 6/31/2020 with a diagnosis of achalasia. Demographics, comorbidities, Eckardt scores, interventions, complications, time to consult, duration of symptoms, and follow-up were evaluated. Read More

Mol Genet Genomic Med 2022 May 15:e1966. Epub 2022 May 15.

Department of Neurology, Mayo Clinic, Jacksonville, Florida, USA.

Background: Achalasia-addisonianism-alacrima syndrome, frequently referred to as Allgrove syndrome or Triple A syndrome, is a multisystem disorder resulting from homozygous or compound heterozygous pathogenic variants in the gene encoding aladin (AAAS). Aladin is a member of the WD-repeat family of proteins and is a component of the nuclear pore complex. It is thought to be involved in nuclear import and export of molecules. Read More

Gastrointest Endosc 2022 May 11. Epub 2022 May 11.

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

Background And Aims: The etiology of chest pain in achalasia-related esophageal motility disorders (AEMDs) and the frequency and risk factors of persistent chest pain after peroral endoscopic myotomy (POEM) remain unclear.

Methods: A multicenter cohort study including 14 hospitals was conducted to elucidate the characteristics of patients with chest pain and the efficacy of POEM.

Results: Consecutive cases of AEMDs included 2,294 (64. Read More

Cir Esp (Engl Ed) 2022 May 9. Epub 2022 May 9.

Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain.

Objective: To describe the experience of the robotic approach for achalasia surgery in a tertiary center.

Material And Methods: Patients with achalasia who underwent robotic surgery between May 2010 and April 2019 were analyzed. The study variables were collected in a prospective database and a descriptive analysis was performed. Read More

Am Surg 2022 May 11:31348221101473. Epub 2022 May 11.

Department of Surgery, 12326University of Tennessee Health Science Center, Memphis, TN, USA.

Background: Laparoscopic Heller myotomy (LHM) and esophageal balloon dilation (BD) are the two mainstays of achalasia treatment-this study examines the outcomes when they are performed simultaneously without fundoplication.

Methods: All patients undergoing LHM&BD were reviewed for demographic and procedural data, and to see if additional procedures for achalasia had been performed. Patients were surveyed using the Eckardt score and the GERD quality-of-life score (GERD-HRQL) to assess the durability of repair. Read More

Gastroenterology 2022 May 7. Epub 2022 May 7.

Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, TN.

Background And Aims: Studies with limited sample sizes have investigated association of chronic opioid use with motility disorders of esophagogastric junction and esophageal body peristalsis. Our aims were to use a large cohort of patients to assess: 1) the impact of opioid exposure on clinical and manometric characteristics and 2) the association of opioid exposure with higher long-term symptom burden.

Methods: Patients recruited from a tertiary medical center who underwent high-resolution manometry (HRM) between 2007 and 2018 were included. Read More

Chirurgia (Bucur) 2022 Apr;117(2):180-186

Achalasia is a motility disorder characterized by the absence of optimal relaxation of the lower esophageal sphincter (LES) with swallowing and lack of peristalsis of the esophageal body. Excepting temporary medical options, the treatment aims to lower the LES pressure by endoscopic or surgical means. Either method involves a risk of perforation. Read More

Chirurgia (Bucur) 2022 Apr;117(2):154-163

The best way to start a paper like this is with a citation from W. Edwards Deming: Without data, you're just another person with an opinion. In the era of Evidence-Based Medicine (EBM) every surgical procedure has to be backed up by solid statistical data to offer our patients the best treatment. Read More

Surg Endosc 2022 May 9. Epub 2022 May 9.

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

Background And Aims: Although esophageal smooth muscle fibrosis of achalasia (AC) patients has been described, the role and mechanism remain unclear. The aim of this study was to evaluate the fibrosis in the distal esophageal muscle in patients with AC and explore its relationship with prognosis of per-oral endoscopic myotomy (POEM).

Methods: Lower esophageal sphincter (LES) muscle from forty patients undergoing POEM for AC were obtained at the time of surgery. Read More

World J Surg 2022 May 6. Epub 2022 May 6.

Department of Surgery, University of Virginia, Charlottesville, VA, USA.

Background: Achalasia is a primary esophageal motility disorder characterized by aperistalsis and defective relaxation of the lower esophageal sphincter in response to swallowing. Patients' symptoms include dysphagia, regurgitation, weight loss, chest pain and aspiration. The disease is idiopathic, and the goal of treatment is to eliminate the resistance determined by the abnormal lower esophageal sphincter, therefore allowing passage of the ingested food from the esophagus into the stomach. Read More

Nat Rev Dis Primers 2022 May 5;8(1):29. Epub 2022 May 5.

Nat Rev Dis Primers 2022 May 5;8(1):28. Epub 2022 May 5.

Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO, USA.

Achalasia is a rare disorder of the oesophageal smooth muscle characterized by impaired relaxation of the lower oesophageal sphincter (LES) and absent or spastic contractions in the oesophageal body. The key pathophysiological mechanism is loss of inhibitory nerve function that probably results from an autoimmune attack targeting oesophageal myenteric nerves through cell-mediated and, possibly, antibody-mediated mechanisms. Achalasia incidence and prevalence increase with age, but the disorder can affect all ages and both sexes. Read More

Cureus 2022 Apr 1;14(4):e23735. Epub 2022 Apr 1.

Gastroenterology, Metropolitan Hospital, New York City, USA.

Esophageal leukoplakia refers to a clinical finding of a white patch on the mucous membrane surface that cannot be scraped off. It has been associated with alcohol and tobacco use and chronic acid reflux. An association with squamous cell dysplasia and carcinoma has been reported with potential for malignant transformation warranting endoscopic intervention or surveillance, but no guidelines exist. Read More

Open Med (Wars) 2022 12;17(1):732-740. Epub 2022 Apr 12.

Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China.

Idiopathic achalasia is a primary esophageal motility disorder characterized by the absence of esophageal peristalsis and impaired relaxation of the lower esophageal sphincter (LES). However, the pathogenesis of idiopathic achalasia remains unclear. To further understand the pathogenesis, we conducted lncRNA and mRNA microarray analyses. Read More

J Gen Fam Med 2022 May 3;23(3):195-196. Epub 2022 Feb 3.

Department of Gastroenterology Mito Kyodo General Hospital University of Tsukuba Ibaraki Japan.

In this case, a chest computed tomography scan of a young patient with pneumonia revealed esophageal obstruction, which led to the diagnosis of aspiration pneumonia due to achalasia. This report highlights achalasia and other gastrointestinal obstructions as one of the causes of aspiration pneumonia. Read More

J Gen Fam Med 2022 May 14;23(3):189-190. Epub 2022 Jan 14.

Department of General Medicine Oita University Faculty of Medicine Yufu Oita Japan.

Our case serves as a reminder that clinicians should pay attention to the presence of esophageal diseases in patients with lung abscesses. The esophagus should be evaluated during pulmonary CT imaging. Read More

Surg Endosc 2022 May 3. Epub 2022 May 3.

Department of Surgery, NorthShore University Health System, 2650 Ridge Ave, GCSI Suite B665, Evanston, IL, 60201, USA.

Background: Numerous studies show changes in functional lumen imaging probe (FLIP) measurements after myotomy during peroral endoscopic myotomy (POEM), but few report on FLIP measurements at follow-up esophagogastroduodenoscopy (EGD). The purpose of this study was to compare perioperative FLIP measurements to those at follow-up EGD.

Methods: Patients who underwent POEM with FLIP in the operating room and POEM patients who had EGD with FLIP at follow-up were included. Read More

Cureus 2022 Mar 26;14(3):e23527. Epub 2022 Mar 26.

Department of Endocrinology, Kali Prasad Chowdhury Medical College and Hospital, Kolkata, IND.

Congenital adrenal hypoplasia or adrenal hypoplasia congenita (AHC) is a rare disorder ascribed to mutations in three genes, namely, the dosage-sensitive sex reversal-adrenal hypoplasia congenita critical region on the X chromosome, gene 1 (DAX-1/NROB1 gene), steroidogenic factor-1 gene (SF-1/NR5A1 gene), and Achalasia-Addisonianism-Alacrima syndrome gene (AAAS gene). Five cases of AHC of local South Asian origin are described here. Golden Helix VarSeq 2. Read More

Asian J Surg 2022 Apr 25. Epub 2022 Apr 25.

Emergency and Critical Care Center, Intensive Care Unit, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, 310014, China. Electronic address:

Achalasia(AC) is an esophageal motility disorder characterized by decreased esophageal motility and impaired relaxation of lower esophageal sphincter(LES). The treatment of achalasia is continuously improved for the development of technology, but each treatment has its own advantages and disadvantages. This article was to compare the efficacy and complication of different treatment on AC. Read More

J Gastrointest Surg 2022 Apr 26. Epub 2022 Apr 26.

Asian Institute of Gastroenterology, 6-3-661, Somajiguda, Hyderabad, 500 082, India.

Background: There is limited data on long-term outcomes of per-oral endoscopic myotomy (POEM). In this study, we aim to evaluate the efficacy of POEM in patients who completed a minimum follow-up of 5 years.

Methods: Data of patients who underwent POEM and completed ≥ 5-year follow-up were analyzed, retrospectively. Read More

Int J Med Robot 2022 Apr 26:e2411. Epub 2022 Apr 26.

Department of Robotic General Surgery, Azienda Ospedaliera San Giovanni Addolorata, Rome, Italy.

Background: The robotic Heller-Dor (RHD) procedure for oesophageal achalasia (EA) is safe and effective. We aim to evaluate the intraoperative use of fluorescence imaging, as an alternative means to intraoperative endoscopy, to assess myotomy at the end of the procedure.

Methods: Thirty-four patients affected with EA underwent RHD. Read More

Hong Kong Med J 2022 Apr;28(2):169-171

Division of Esophageal and Upper Gastrointestinal Surgery, Department of Surgery, School of Clinical Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong.

Cureus 2022 Mar 11;14(3):e23061. Epub 2022 Mar 11.

Gastroenterology, New York Medical College, Metropolitan Hospital Center, New York, USA.

Bezoar is a rare entity that is composed of indigested foreign material and is most commonly seen in the stomach. Phytobezoars are the most common type of bezoars and are composed of indigestible cellulose and lignin from fruits and vegetables. We present a unique case of esophageal phytobezoar, which was seen in a patient with long-standing achalasia. Read More

Gastroenterol Res Pract 2022 11;2022:8357588. Epub 2022 Apr 11.

Department of Gastroenterology & Hepatology, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan, China.

Introduction: Currently, there are few studies on the efficacy of peroral endoscopic myotomy (POEM) in the anterior or posterior approach; however, limited studies have shown contradictory findings. Thus, the goal was to obtain more quantitative and objective outcomes and further compare the clinical efficacy of these two approaches in this meta-analysis.

Methods: A comprehensive search of PubMed, Embase, Cochrane Library, and Web of Science was conducted to find studies relevant to POEM. Read More

Gastroenterol Hepatol (N Y) 2021 Oct;17(10):468-475

University of South Florida Morsani College of Medicine, Tampa, Florida.

High-resolution manometry (HRM) has revolutionized esophageal motility testing, and the evolving Chicago Classification has been critical in codifying HRM metrics and definitions of old and new motility disorders. The latest Chicago Classification (version 4.0) is the result of a working group of 52 members (10 women) from 20 countries. Read More