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Esophageal Disorders and Their Relationship to Psychiatric Disease
Published in Kevin W. Olden, Handbook of Functional Gastrointestinal Disorders, 2020
Laurence A. Bradley, Joel E. Richter
Given the straightforward relationships between the biological components and the symptoms of achalasia, little attention has been devoted to the psychiatric and psychosocial dimensions of this disorder. Accordingly, the preferred initial treatment for achalasia is pneumatic dilatation (47). This procedure produces long-term relief of dysphagia and chest pain in 75 to 80% of patients; however, it reduces pain in only 50% of patients with vigorous achalasia (48). Esophageal myotomy also relieves dysphagia in 80 to 90% of achalasia patients. Unfortunately, it may produce esophageal reflux as a side effect that requires treatment on a continual basis (49).
Upper GI
Published in Stephen Brennan, FRCS General Surgery Viva Topics and Revision Notes, 2017
Heller myotomy helps 90% of achalasia patients. The myotomy is a lengthwise cut along the oesophagus, starting above the LOS and extending down onto the stomach a little way. A partial fundoplication or ‘wrap’ is generally added in order to prevent excessive reflux, which can cause serious damage to the oesophagus over time. After surgery, patients should keep to a soft diet for several weeks to a month, avoiding foods that can aggravate reflux.
Outcome of peroral endoscopic myotomy (POEM) in treatment-naive patients. A systematic review
Published in Scandinavian Journal of Gastroenterology, 2018
Helge Evensen, Vendel Kristensen, Lene Larssen, Olav Sandstad, Truls Hauge, Asle W. Medhus
The identified studies all presented a short-term clinical success rate of >90% (Table 2). Clinical success was defined as an Eckardt score ≤3. Zhang et al. demonstrated a 91% clinical efficacy in subtype 3 achalasia with a mean myotomy length of 8.2 cm [40]. All the patients in the included studies were available for symptom assessment prior to POEM and during follow-up, except for two patients in the series of Teitelbaum et al. [41]. HRM was applied pre and post POEM in the included studies, describing a significant decrease in LES-pressure after POEM. In the four studies presenting percentage of patients evaluated by objective tests post POEM, this number varied between 47 and 100% [27,40–42]. Additionally, Ling et al. and Meng et al. reported the post-POEM LES-pressure categorically, demonstrating a LES-pressure <10 mm Hg in 99 and 88% of the patients, respectively [27,37]. Only two studies included a TBE protocol with barium height analysis in their outcome evaluation [37,41]. The included studies reported standard timing of physiologic testing post POEM, except for Shiwaku et al. and Ling et al. [37,38]. The follow-up period varied between three and 51 months. The only study with a minimum of 24 months follow-up was on achalasia subtype 3 exclusively [40].