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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

World J Gastroenterol 2019 Jan;25(4):411-417

Department of Medicine, Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA 30322, United States.

Esophagogastric junction outflow obstruction (EGJOO) is a major motility disorder based on the Chicago Classification of esophageal motility disorders. This entity involves a heterogenous group of underlying etiologies. The diagnosis is reached by performing high-resolution manometry. Read More

Tohoku J Exp Med 2019 ;247(1):41-49

Division of Gastroenterology and Hepatobiliary Pancreatic Surgery, Tohoku Medical and Pharmaceutical University.

Esophageal achalasia is a disease characterized by the impaired esophageal peristalsis and non-relaxation of the lower esophageal sphincter muscle with unknown causes. Clinical manifestation of the disease is nonspecific (e.g. Read More

Tunis Med 2018 May;96(5):311-313

The association achalasia and non tuberculous Mycobacteria lung infection is described in the literature. Most of the time Mycobacterium Fortuitum is responsible of aspiration pneumonia that didn't respond to usual antibiotic therapy. We report a new case about a 15 year-old woman with Allgrove's syndrome history. Read More

Gut Liver 2019 01;13(1):32-39

Department of Gastroenterology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea.

Background/aims: Endoluminal functional lumen imaging probe (EndoFLIP) is a modality that enables clinicians to measure volume-controlled distension of the esophagus. This study aimed to assess the utility of EndoFLIP in patients who had achalasia treated with peroral endoscopic myotomy (POEM). We hypothesized that improvement in the distensibility index (DI) is correlated with the postoperative clinical outcome of POEM. Read More

Tunis Med 2018 Mar;96(3):227-229

The association between achalasia and no tuberculosis mycobacterial   lung infection is well described in the literature. MycobactériumFortuitum is often responsible, and the clinical's presentation   is an aspiration pneumonia resistant to usual antibiotic therapy. We report the case of a 15 year-old patient with the history of Allgrove syndrome. Read More

Kyobu Geka 2018 09;71(10):894-899

Department of General Surgical Science, Gunma University, Graduate School of Medicine, Maebashi, Japan.

High-resolution manometry (HRM) has significant contribution in the field of esophageal motility disorders recently. The development of HRM has categorized various esophageal motility disorders focusing on patterns of esophageal motor function. Additionally, the Chicago classification criteria are widely used for manometric diagnosis. Read More

J Med Imaging Radiat Oncol 2018 Oct;62 Suppl 1:58

Department of Radiology, Concord Repatriation General Hospital, Concord, New South Wales, Australia.

J Gastrointest Surg 2019 Jan 4;23(1):36-42. Epub 2018 Oct 4.

Center for Advanced Surgical Technology, University of Nebraska Medical Center, 986246 Nebraska Medical Center, Omaha, NE, 68198-6246, USA.

Background: Gastroesophageal reflux disease (GERD) and esophageal dysmotility are often disqualifying criteria for fundoplication due to dysphagia complications. A tailored partial fundoplication may improve GERD in patients with severe esophageal motility disorders. We evaluate this approach on GERD improvement in non-achalasia esophageal dysmotility patients. Read More

Thorac Surg Clin 2018 Nov;28(4):555-566

Foregut Surgeon, The Oregon Clinic, 4805 Northeast Glisan Street, Suite 6N60, Portland, OR 97213, USA.

The understanding of esophageal function and dysfunction in a variety of disease states has been driven largely by the introduction of a variety of measurement technologies. Included in these are contrast esophagram, computed tomography, high-resolution manometry, and 24-hour pH monitoring. Two novel measurement technologies, the functional lumen imaging probe (FLIP) and mucosal impedance (MI) catheter have recently introduced and studied. Read More

Mayo Clin Proc Innov Qual Outcomes 2017 Sep 2;1(2):198-201. Epub 2017 Aug 2.

Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD.

Calcineurin inhibitors (CNIs) are effective agents used for prevention of graft-vs-host disease after allogeneic hematopoietic stem cell transplant or for organ rejection in solid-organ transplant. However, CNIs have a wide range of adverse effects that may necessitate changing to another CNI or immunosuppressive agent. We report a case of acute myeloid leukemia in which achalasia developed after exposure to tacrolimus, as revealed by esophagram results. Read More

Clin Gastroenterol Hepatol 2018 Aug 3. Epub 2018 Aug 3.

Division of Gastroenterology and Hepatology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.

Background & Aims: Functional luminal imaging probe (FLIP) panometry provides a comprehensive evaluation of esophageal functional at the time of endoscopy, including assessment of esophageal distensibility and distension-induced esophageal contractility. However, the few and inconsistent findings from healthy individuals pose challenges to the application of FLIP to research and clinical practice. We performed FLIP panometry in asymptomatic volunteers. Read More

Endoscopy 2018 Aug 1. Epub 2018 Aug 1.

Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.

Background:  The outcome of peroral endoscopic myotomy (POEM) in patients with prior Roux-en-Y gastric bypass (RYGB) is not known and some experts have recommended against its performance in this patient population because of the risk of postoperative regurgitation. The aim of this study was to report on the outcomes of POEM in patients with RYGB anatomy.

Methods:  Patients with RYGB anatomy who underwent POEM for the treatment of achalasia at three tertiary centers were included. Read More

PLoS One 2018 12;13(7):e0200446. Epub 2018 Jul 12.

Dipartimento di Medicina di Precisione, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy.

Background And Purpose: Moyamoya angiopathy is a progressive cerebral vasculopathy. The p.R4810K substitution in RNF213 has previously been linked to moyamoya disease in Asian populations. Read More

J Laryngol Otol 2018 Sep 18;132(9):852-855. Epub 2018 Jun 18.

Department of Otolaryngology,Louisiana State University,Children's Hospital New Orleans,USA.

Objective: To describe a case of concurrent cricopharyngeal achalasia with laryngomalacia as a cause of failure to thrive, and to review the literature and management options of cricopharyngeal achalasia in the paediatric population.

Methods: A chart review was performed on a four-month-old male, referred for failure to thrive, and diagnosed with cricopharyngeal achalasia and laryngomalacia. A PubMed and Embase search for 'cricopharyngeal achalasia' and 'laryngomalacia' was conducted. Read More

Esophagus 2018 01 18;15(1):39-46. Epub 2017 Sep 18.

Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishishimbashi, Minato-ku, Tokyo, 105-8461, Japan.

Background: Balloon dilatation is reportedly less effective for young patients with esophageal achalasia than for older patients. However, there is no consensus on the impact of prior balloon dilatation on outcomes of surgical treatment. This study investigated the significance of preoperative balloon dilatation on surgical outcomes in young patients with esophageal achalasia. Read More

Medicine (Baltimore) 2018 Jun;97(23):e11016

Department of Paediatric Surgery, University Basel Children's Hospital, Spitalstrasse, Basel, Switzerland.

Rationale: Esophageal achalasia is characterized by impaired relaxation of the cardia and dilation of the intrathoracic part of the esophagus. We describe the late presentation of achalasia in an 11-year old girl.

Patient Concerns: She suffered from recurrent pneumonia, obstructive bronchitis, and problems with swallowing solid food. Read More

Gastroenterology 2018 08 5;155(2):327-336. Epub 2018 May 5.

Department of Medicine, Division of Gastroenterology, University of California, San Diego, California. Electronic address:

Background & Aims: In patients with achalasia esophagus, swallows induce simultaneous pressure waves known as esophageal pressurization. We studied the mechanism of esophageal pressurization and bolus flow patterns in patients with type 2 or type 3 achalasia.

Methods: We recorded high-resolution manometry with impedance and intraluminal ultrasound images concurrently in patients with type 2 achalasia (n = 6) or type 3 achalasia (n = 8) and in 10 healthy subjects (controls) during swallows of 5 mL of 0. Read More

J Emerg Med 2018 07 24;55(1):e19-e21. Epub 2018 Apr 24.

Department of Nephrology and General Internal Medicine, University Hospital of Cologne, Cologne, Germany.

Clin Gastroenterol Hepatol 2018 Nov 24;16(11):1692-1700. Epub 2018 Apr 24.

Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.

The widespread adoption of high-resolution manometry (HRM) has led to a restructuring in the classification of esophageal motility disorder classification summarized in the Chicago Classification, currently in version 3.0. It has become apparent that the cardinal feature of achalasia, impaired lower esophageal sphincter relaxation, can occur in several disease phenotypes: without peristalsis, with premature (spastic) distal esophageal contractions, with panesophageal pressurization, or even with preserved peristalsis. Read More

Digestion 2018 26;98(2):95-103. Epub 2018 Apr 26.

Background And Aim: Although basic research has shown that certain cytokines affect gastrointestinal motility, the clinical evidence is lacking. The objective of this study was to explore the association between mucosally expressed cytokines and the esophageal motility function in humans.

Methods: We enrolled a total of 57 patients with suspected esophageal motility disorders (EMDs) who underwent high-resolution manometry. Read More

J Thorac Cardiovasc Surg 2018 Aug 8;156(2):871-877.e2. Epub 2018 Mar 8.

Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio. Electronic address:

Objectives: The value of routine timed barium esophagram (TBE) in longitudinal follow-up of achalasia after Heller myotomy is unknown. We prospectively prescribed a yearly follow-up TBE. Purposes were to characterize esophageal emptying over time after myotomy, identify preoperative TBE measures associated with follow-up TBE, and characterize follow-up TBE over time in relationship to reintervention. Read More

Am Surg 2018 Feb;84(2):165-173

Florida Hospital Tampa, Tampa, Florida, USA.

This study was undertaken to determine whether postoperative outcomes after laparoscopic Heller myotomy with anterior fundoplication could be predicted by preoperative findings on esophagography. Preoperative barium esophagograms of 135 patients undergoing laparoscopic Heller myotomy with anterior fundoplication were reviewed. The number of esophageal curves, esophageal width, and angulation of the gastroesophageal junction (GEJ) were determined; correlations between these determined parameters and symptoms were assessed using linear regression analysis. Read More

Curr Probl Surg 2018 Jan 31;55(1):10-37. Epub 2018 Jan 31.

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

Medicine (Baltimore) 2018 Mar;97(10):e0084

Department of Surgery.

The aim of this study was to determine the esophageal transit time in control individuals and in chagasic patients with or without megaesophagus.A total of 148 patients were allocated in 6 groups according to serological diagnostic of Chagas disease and the degree of esophageal dilatation: A, control healthy individuals (n = 34, 22.9%); B, indeterminate form (n = 23, 15. Read More

Clin Nucl Med 2018 May;43(5):377-378

We report the case of a 49-year-old woman with achalasia in whom thyroid stimulating hormone supression was incidentally detected on routine blood tests and who therefore underwent thyroid scintigraphy. Thyroid scan demonstrated low intensity diffuse technetium Tc sodium pertechnetate accumulation inferior to thyroid gland. After correlating the images with her previous barium esophagogram, tracer accumulation caudal to thyroid gland was explained on the presumption of Tc sodium pertechnetate retention within the dilated esophagus. Read More

Medicine (Baltimore) 2018 Jan;97(2):e9609

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

Rationale: Retrograde gastroesophageal intussusception (RGEI) is a relatively rare gastrointestinal (GI) disorder in which a portion of the stomach wall invaginates into the esophagus. More recently, peroral endoscopic myotomy (POEM) has emerged as an endoscopic alternative to surgical myotomy for achalasia, and, to the best of our knowledge, our case is the first RGEI after POEM to be reported.

Patient Concerns: A 22-year-old male was presented with a history of vomiting, intractable retching and hematemesis for 3 days. Read More

Am J Gastroenterol 2018 Feb;113(2):213-215

Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.

Achalasia is currently diagnosed according to the Chicago Classification v3.0 using high-resolution manometry and treatment focuses on disruption of the esophagogastric junction. A paper in this issue examines the utility of a timed barium esophagram with a 13 mm tablet challenge in differentiating achalasia from other diagnoses, finding 100% sensitivity. Read More

Am J Physiol Gastrointest Liver Physiol 2018 03 21;314(3):G334-G340. Epub 2017 Dec 21.

Division of Gastroenterology and Hepatology, Department of Medicine, Feinberg School of Medicine, Northwestern University , Chicago, Illinois.

Repetitive retrograde contractions (RRCs) in response to sustained esophageal distension are a distinct contractility pattern observed with functional luminal imaging probe (FLIP) panometry that are common in type III (spastic) achalasia. RRCs are hypothesized to be indicative of either impaired inhibitory innervation or esophageal outflow obstruction. We aimed to apply FLIP panometry to patients with postfundoplication dysphagia (a model of esophageal obstruction) to explore mechanisms behind RRCs. Read More

Scand J Gastroenterol 2018 Mar 17;53(3):252-255. Epub 2018 Jan 17.

a Department of Gastroenterology and Hepatology , Academic Medical Center, University of Amsterdam , Amsterdam , The Netherlands.

Objective: Distal esophageal spasm (DES) is a rare motility disorder characterized by premature and rapidly propagated contractions of the distal esophagus. Treatment options are limited and often poorly effective. Peroral endoscopic myotomy (POEM) seems an effective and attractive new treatment option for DES. Read More

Quant Imaging Med Surg 2017 Dec;7(6):727-731

Department of Advanced Biomedical Sciences, Neuroradiology Unit, University of Naples "Federico II", Naples, Italy.

Motor neuron disease (MND) is a neurodegenerative disease determining progressive and relentless motor deterioration involving both upper and lower motor neurons (UMN and LMN); several variants at onset are described. Here we describe a case of MND presenting as pure spastic monoparesis in which magnetic resonance imaging (MRI) gave a substantial contribution in confirming the diagnosis and assessing the severity of UMN involvement. An isolated pyramidal syndrome, with complete absence of LMN signs, is a rare phenotype in the context of MND (less than 4% of total cases), especially if restricted to only one limb. Read More

J Laparoendosc Adv Surg Tech A 2018 Mar 7;28(3):343-347. Epub 2017 Dec 7.

Department of Surgery, University of Hong Kong Medical Center , Queen Mary Hospital, Hong Kong SAR, China .

Background: Experience of peroral endoscopic myotomy (POEM) for treatment of achalasia in pediatric population is limited with varying techniques in different centers. The accurate extent of submucosal tunneling into the gastric cardia and the adequacy of myotomy are the important determining factors to success of POEM. A majority of studies in pediatric population have described using submucosal dye injection for assessing the adequacy of myotomy, however, this is a rather crude and inaccurate method. Read More

Am J Gastroenterol 2018 Feb 5;113(2):205-212. Epub 2017 Dec 5.

Department of Gastroenterology and Hepatology, St George Hospital, Sydney, NSW, Australia.

Objectives: Often 2-3 graduated pneumatic dilatations (PD) are required to treat achalasia as there is no current intra-procedural predictor of clinical response. Distensibility measurements using functional lumen imaging probe (FLIP) may provide an intra-procedural predictor of outcome. Our aim was to determine the optimal criterion for esophagogastric junction (EGJ) distensibility measurements during PD that predicts immediate clinical response. Read More

Turk J Gastroenterol 2017 12;28(Suppl 1):S16-S21

Department of Gastroenterology, Necmettin Erbakan University School of Medicine, Konya, Turkey

Ambulatory esophageal pH monitoring is an essential method in patients exhibiting signs of non-erosive reflux disease (NERD) to make an objective diagnosis. Intra-esophageal pH monitoring is important in patients who are non-responsive to medications and in those with extraesophageal symptoms, particularly in NERD, before surgical interventions. With the help of the wireless capsule pH monitoring, measurements can be made under more physiological conditions as well as longer recordings can be performed because the investigation can be better tolerated by patients. Read More

J Gastroenterol Hepatol 2018 May 15;33(5):1067-1074. Epub 2018 Feb 15.

Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Medical Center of Leipzig, Leipzig, Germany.

Background And Aim: Pneumatic dilation (PD) is the most popular nonsurgical treatment for achalasia. This study investigated predicting factors, including manometric subtypes for symptom recurrence in the long term, in patients with achalasia treated with a single PD.

Methods: Between 1983 and 2013, a total of 107 patients were treated initially with a single PD and included in this longitudinal cohort study. Read More

Endoscopy 2018 02 14;50(2):E38-E41. Epub 2017 Nov 14.

Department of Endoscopy and Gastroenterology, Pavillon L, Hôpital Edouard Herriot, Lyon, France.

Gastrointest Endosc 2018 Apr 2;87(4):934-943.e18. Epub 2017 Nov 2.

Digestive Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy.

Background And Aims: Per-oral endoscopic myotomy (POEM) represents a less invasive alternative to conventional laparoscopic Heller's myotomy (LHM) for patients with achalasia. It cannot be excluded, however, that the lack of fundoplication after POEM may result in a higher incidence of reflux disease, as compared with LHM. The aim of our study was to conduct a systematic review of prospective studies reporting the incidence of reflux disease developed after POEM and LHM. Read More

World J Gastroenterol 2017 Oct;23(37):6902-6906

Department of Internal Medicine, University of Missouri-Kansas City, Kansas City, MO 64108, United States.

Achalasia is a rare esophageal motility disorder that is characterized by a loss of peristalsis in the distal esophagus and failure of lower esophageal sphincter relaxation. The risk of developing esophageal motility disorders, including achalasia, following bariatric surgery is controversial and differs based on the type of surgery. Most of the reported cases occurred with laparoscopic adjustable gastric banding. Read More

BMJ Case Rep 2017 Oct 15;2017. Epub 2017 Oct 15.

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

Here, we present a case of a 50-year-old male with a history of a Guillain-Barré-syndrome, who was referred to our clinic with recurrent esophageal candidiasis and long-standing intermittent retrosternal cramps for further evaluation. Other symptoms such as dysphagia, regurgitations and weight loss were denied, and prior repeated endoscopy was otherwise unremarkable. Using high resolution impedance manometry, we could demonstrate a panesophageal pressure increase on water swallows and complete aperistalsis of the tubular esophagus, indicating achalasia type II. Read More

Endoscopy 2017 12 9;49(12):E311-E312. Epub 2017 Oct 9.

Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China.

Gastrointest Endosc 2018 Apr 6;87(4):1151-1152. Epub 2017 Oct 6.

Asian Institute of Gastroenterology, Hyderabad, India.

Abdom Radiol (NY) 2018 Jun;43(6):1482-1493

Division of Gastroenterology & Hepatology, Department of Medicine, University of California, Irvine, 3rd Floor, 101 The City Dr South, Bldg 23, Orange, CA, 92868, USA.

Natural orifice transluminal endoscopic surgery (NOTES) is a novel surgical approach, currently performed for an array of conditions. Endoscopic procedures offer significant benefits, including lower cost, no surgical incisions, and shorter hospital stays. These advantages align with the current trends in health care, namely a push for "cost-effective care. Read More

Surg Obes Relat Dis 2017 11 25;13(11):1927-1928. Epub 2017 Aug 25.

St. Luke's University Health Network, Allentown, PA.

Endoscopy 2017 Dec 12;49(12):1209-1218. Epub 2017 Sep 12.

Division of Endoscopy, Specialties Hospital, National Medical Center Century XXI, Mexico City, Mexico.

 Peroral endoscopic myotomy (POEM) is an excellent endoscopic treatment for achalasia. Clinical and manometric parameters are used for evaluation and follow-up. However, clinical success does not guarantee high quality of life (QoL) scores, generating doubts about their direct relationship. Read More

Dig Endosc 2018 Mar 3;30(2):260-262. Epub 2017 Oct 3.

Internal Gastroenterological Clinic - Jessenius Faculty of Medicine, Martin, Slovakia.

Symptomatic epiphrenic diverticula are mostly treated surgically with laparoscopic diverticulectomy, myotomy and anterior fundoplication. However, in case the patient does not agree with surgical therapy or is contraindicated, there are limited ways of alternative treatment. We present a case report of a 72-year-old female patient with severe dysphagia, regurgitation, paroxysmal cough, weight loss and malnutrition who was diagnosed with achalasia and large epiphrenic diverticulum. Read More

Dis Esophagus 2017 Dec;30(12):1-6

Departments of Gastroenterology and Hepatology.

The classic manometric findings in systemic sclerosis are aperistalsis of the esophageal body with hypotensive lower esophageal sphincter. These changes contribute to gastroesophageal reflux disease in these patients. With widespread use of high-resolution esophageal manometry, diverse abnormalities are seen. Read More

Ultrasound Q 2017 Dec;33(4):303-304

Abdominal ultrasound of a 28-year-old man with chronic abdominal pain and vomiting demonstrates a dilated aperistaltic distal esophagus, which was confirmed on follow-up esophagram as achalasia. The 2 main types of achalasia are primary and secondary. Primary achalasia occurs with the loss of postganglionic neurons resulting in failed distal esophageal relaxation. Read More

Ann R Coll Surg Engl 2017 Sep 15;99(7):e202-e203. Epub 2017 Aug 15.

Tianjin Medical University General Hospital , China.

Oesophagogastric invagination is a relatively rare disease that is primarily caused by a sliding hiatal hernia. We report a successfully treated case of oesophagogastric invagination caused by achalasia. Oesophagogastric invagination should be considered in patients complaining of upper abdominal discomfort. Read More

Adv Surg 2017 09 2;51(1):193-205. Epub 2017 May 2.

Department of Surgery, Northwestern University Feinberg School of Medicine, Northwestern University, 251 East Huron, Galter 3-150, Chicago, IL 60611, USA.

Turk J Gastroenterol 2017 Jul;28(4):316-318

Department of Radiodiagnosis and Imaging, Bananas Hindu University Institute of Medical Sciences, Varanasi, India.