| Achalasia is a motility disorder characterized by esophageal aperistalsis and nonrelaxation of the lower esophageal sphincter (LES). Most patients with achalasia suffer from their symptoms for a prolonged period before receiving a correct diagnosis. The diagnosis of achalasia might be occasionally delayed because symptoms are misinterpreted as gastroesophageal reflux disease (GERD). Therefore, patients who complain of dysphagia should be evaluated by manometry when obstruction is excluded by endoscopy. Chronic retention of food in patients with achalasia leads to “stagnation” or “retention” esophagitis. High resolution manometry (HRM) is currently standard for assessing esophageal motility disorders. HRM has allowed for the differentiation of achalasia into three subtypes or variants with treatment-outcome implications. Timed barium esophagogram (TBE) and esophageal transit scintigraphy (ETS) are useful modalities in assessing esophageal emptying and response to achalasia treatment. TBE and ETS results have a statistically significant correlation both pre- and post-treatment. Because TBE has merit as a simple, non-invasive, and convenient method, TBE could effectively replace ETS for the assessment of treatment response of achalasia. The goals in treating achalasia are to relieve the patient’s symptoms by lowering the pressure of LES. Definitive treatment options in achalasia include pneumatic dilation (PD), Heller’s myotomy (HM), and per-oral endoscopic myotomy (POEM). Both PD and HM showed comparably high success. Unlike PD and HM, POEM allows myotomy of any lengths, position, and direction. Accumulating data about POEM demonstrate excellent short-term outcomes with minimal risk of major adverse events, and some existing long-term data show the efficacy of POEM to be long lasting. |
