Management of idiopathic achalasia: drugs, balloon or knife?

Abstract

Achalasia is an uncommon, but not rare, primary oesophageal motor disorder affecting the myenteric neurons of the oesophagus characterised by impaired lower oesophageal sphincter (LES) relaxation and loss of oesophageal peristalsis. There is evidence for a selective loss of the non-adrenergic and non-cholinergic inhibitory ganglion cells and postganglionic neurons in the LES and oesophageal body with preservation of the majority of cholinergic innervation to the oesophagus. Even though treatment has traditionally been endoscopic or surgical, recent advances in treating patients with achalasia have led to the development of new therapeutic options, such as the LES injection of botulinum A toxin. Some of the new insights reported in the literature on the genetic basis and pathogenesis of a growing number of secondary forms of achalasia may lead to new therapeutic options. This review will focus on the use of drugs, methodology and outcomes of the established techniques such as dilation and surgical myotomy. In particular, pharmacological efforts towards modifying neurological controls of this oesophageal motility disorder aimed at improving LES function are also discussed.

• achalasia
• dilation
• drugs
• surgery