Evaluation of esophageal achalasia: from symptoms to the chicago classification / Avaliação diagnóstica da acalásia do esôfago: dos sintomas à classificação de chicago

ABSTRACT Introduction: The diagnosis of achalasia may be suggested by clinical features but a complete work-up is required not only to confirm the diagnosis but also to grade the disease by severity or clinical subtype. Objective: To review the current evaluation of esophageal achalasia and its correct comprehension. Method: The literature review was based on papers published on Medline/Pubmed, SciELO and Lilacs, crossing the following headings: "esophageal achalasia"; "deglutition disorders"; "diagnostic techniques", "digestive system"; "endoscopy, digestive system"; "manometry". Results: The diagnosis of achalasia is suggested by clinical features but is not sufficient to distinguish this from other esophageal disease. It must be confirmed by further diagnostic tests, such as esophagogastroduodenoscopy, barium swallow and manometry. Recent advances in diagnostic methods, including high resolution manometry might even help predicting outcome or selected more appropriate procedures to treat the disease. Conclusion: A detailed and systematic study of achalasia patients allows not only a correct diagnosis but also contributes to therapeutic decision making and prognosis.

RESUMO Introdução: O diagnóstico da acalásia pode ser sugerido pelo quadro clínico; porém, completa investigação se faz necessária não apenas para confirmar o diagnóstico, mas, também, para estratificar a doença quanto à gravidade ou sub-tipo clínico. Objetivo: Revisar os atuais métodos diagnósticos da acalásia do esôfago e sua correta interpretação. Método: Revisão da literatura realizada nas bases de dados Medline/Pubmed, SciELO e Lilacs, cruzando-se os descritores "acalásia esofágica", "transtornos de deglutição", "técnicas de diagnóstico do sistema digestório", "endoscopia do sistema digestório" e "manometria". Resultados: O diagnóstico da acalásia é sugerido pelo quadro clínico, o qual, no entanto, é insuficiente para diferenciar esta doença de outras afecções esofágicas. O diagnóstico deve ser confirmado por endoscopia digestiva, estudo radiológico contrastado e manometria. Recentes avanços nos métodos diagnósticos, incluindo a manometria de alta resolução, podem também auxiliar no estabelecimento do prognóstico da doença ou na escolha da melhor modalidade de tratamento a ser realizada. Conclusão: Estudo detalhado e sistemático dos pacientes portadores de acalásia permite não apenas diagnóstico correto, mas também contribui na escolha da melhor opção terapêutica e estabelecimento do prognóstico destes indivíduos.

Reintervenciones por fracaso de la miotomía de Heller por acalasia esofágica / Reintervention after failed Heller myotomy for esophageal achalasia

Introducción: la cardiomiotomía de Heller asociada al proceder antirreflujo descrito por Dor constituye el tratamiento de elección en los pacientes con acalasia esofágica; sin embargo, las causas del fracaso del tratamiento aún son controversiales. Objetivo: describir las causas del fracaso de la miotomía de Heller en pacientes operados por acalasia esofágica y la evolución clínica de los pacientes reintervenidos. Métodos: se realizó un estudio descriptivo, retrospectivo y longitudinal de una serie de pacientes reintervenidos por fracaso de la miotomía de Heller en el Centro Nacional de Cirugía de Mínimo Acceso desde enero de 2010 hasta diciembre de 2016. Resultados: se les realizó miotomía de Heller a 253 pacientes con diagnóstico de acalasia esofágica. De ellos, 7 (2,7 por ciento) fueron reintervenidos por recurrencia de los síntomas, 4 (1,5 por ciento) fueron operados inicialmente en la institución y el resto fueron remitidos de otras instituciones del país. La edad media fue de 41 ± 15 años (rango 20-59). Los síntomas más frecuentes fueron la disfagia posoperatoria y la pérdida de peso (100 por ciento). El tiempo de recurrencia de los síntomas después de la primera operación fue de 6-12 meses en 4 (57 por ciento), de 12 a 18 meses en 1 (16 por ciento) y de 18 a 24 en 2 (33 por ciento) pacientes. Conclusiones: la miotomía incompleta fue la causa principal de reintervención. La remiotomia laparoscópica con o sin fundoplicatura fue la técnica quirúrgica de elección para estos pacientes los cuales tuvieron una evolución clínica excelente o buena en el posoperatorio(AU)

Introduction: Heller's cardiomyotomy associated with the antireflux procedure described by Dor is the treatment of choice in patients with esophageal achalasia. However, the causes of treatment failure are still controversial. Objective: To describe the causes of failure of Heller's myotomy in patients operated for esophageal achalasia and the clinical progress of patients who required another surgery. Methods: A descriptive, retrospective and longitudinal study was performed in a series of patients who required another surgery due to failed Heller's myotomy at the National Center for Minimally Invasive Surgery from January 2010 to December 2016. Results: Heller's myotomy was performed in 253 patients diagnosed with esophageal achalasia. Among these patients, 7 (2.7 percent) required another surgery due to the relapse of symptoms, 4 (1.5 percent) were initially operated at the institution, and the rest were referred from other institutions in the country. The average age was 41±15 years (range 20-59). The most frequent symptoms were postoperative dysphagia and weight loss (100 percent). The time of symptoms relapse after the first surgery was 6-12 months in 4 patients (57 percent), 12-18 months in 1 (16 percent) and 18-24 months in 2 (33 percent) patients. Conclusions: Incomplete myotomy was the main cause of reintervention, laparoscopic myotomy with or without fundoplication being the surgical technique of choice for these patients, who had an excellent or good postoperative clinical evolution(AU)

Caracterización de pacientes con acalasia en Cuba (2006-2015) / Characterization of achalasia patients in Cuba (2006-2015)

Introducción: la acalasia es una enfermedad motora primaria del esófago con daño de la función del esfínter esofágico inferior y aperistalsis del cuerpo esofágico. Su etiología es desconocida. Objetivo: observar el comportamiento de la epidemiología y características de pacientes con acalasia, atendidos en el Centro Nacional de Cirugía de Mínimo Acceso. Métodos: se realizó un estudio retrospectivo, descriptivo y observacional en pacientes con acalasia, diagnosticados por manometría esofágica convencional, atendidos en el Centro Nacional de Cirugía de Mínimo Acceso desde enero del 2006 hasta diciembre de 2015. Resultados: se diagnosticaron 322 pacientes con acalasia a través de la manometría. La enfermedad fue más frecuente en mujeres que se encontraban en la cuarta década de la vida, con más de 4 años de evolución y sin una asociación con otras enfermedades. En la manometría esofágica se registró la pobre relajación del esfínter esofágico inferior y ausencia de peristalsis. Conclusiones: fueron identificados los rasgos típicos de la enfermedad, al ser importante el seguimiento clínico del paciente con disfagia para lograr el diagnóstico definitivo de la enfermedad(AU)

Introduction: Achalasia is a primary esophageal motor disease with lower esophageal sphincter impairment and esophageal aperistalsis. Its etiology is unknown. Objective: To observe the epidemiological behavior and characteristic of achalasia patients treated at the National Center for Minimal Invasive Surgery. Methods: A retrospective, descriptive and observational study was performed with achalasia patients, diagnosed through conventional esophageal manometry and treated at the National Center for Minimal Invasive Surgery from January 2006 to December 2015. Results: 332 patients were diagnosed with achalasia through manometry. The disease was more frequent in women at the forth decade of life, with more than 4 years of natural history, and without any association to other diseases. The esophageal manometry registered the poor relaxation of the lower esophageal sphincter and no peristalsis. Conclusions: The disease typical features were identified, on being important the dysphagia patient's clinical follow-up in order to have a final diagnosis of the disease(AU)

The Pathogenesis and Management of Achalasia: Current Status and Future Directions

Achalasia is an esophageal motility disorder that is commonly misdiagnosed initially as gastroesophageal reflux disease. Patients with achalasia often complain of dysphagia with solids and liquids but may focus on regurgitation as the primary symptom, leading to initial misdiagnosis. Diagnostic tests for achalasia include esophageal motility testing, esophagogastroduodenoscopy and barium swallow. These tests play a complimentary role in establishing the diagnosis of suspected achalasia. High-resolution manometry has now identified three subtypes of achalasia, with therapeutic implications. Pneumatic dilation and surgical myotomy are the only definitive treatment options for patients with achalasia who can undergo surgery. Botulinum toxin injection into the lower esophageal sphincter should be reserved for those who cannot undergo definitive therapy. Close follow-up is paramount because many patients will have a recurrence of symptoms and require repeat treatment.

Achalasia secondary to lung adenocarcinoma

No abstract available.

Diagnóstico y tratamiento de la acalasia esofágica / Diagnosis and treatment of esophageal achalasia

Esophageal idiopathic achalasia is a complex disease associated with loss of neuronal Auerbach Plexus in the esophagus, and possibly caused by specific anti-neural antibodies, characterized by incomplete relaxation of the lower esophageal sphincter (LES), together with progressive loss of esophageal body motility. Its cardinal symptom is dysphagia which is accompanied by intermittent chest pain and pseudoregurgitation. A barium swallow shows a classic regular obstruction at the esophago-gastric junction and typical manometry features, being incomplete relaxation of LES the essential element. The goal of management is palliation of dysphagia and is based on endoscopic or surgical LES myotomy with the purpose of reducing the obstructive effect of incomplete-relaxing LES. Endoscopic dilation and endoscopic and surgical myotomy procedures are evolving to provide greater efficacy and safety in the management of achalasia, resulting in the lower rate of side effects such as gastro-esophageal reflux. Among these therapies, surgical myotomy is the only one that shows acceptable long-term results, however, late complications such as severe gastro-esophageal reflux, Barrett’s esophagus and esophageal carcinoma should alert about side effects of an effective myotomy.

La acalasia esofágica idiopática es una enfermedad compleja asociada a la pérdida del plexo neuronal de Auerbach en el esófago, posiblemente causada por anticuerpos anti-neurales específicos. Se caracteriza por la relajación incompleta e hipertonía del esfínter esofágico inferior (EEI), junto con pérdida progresiva de la motilidad del cuerpo esofágico. Su síntoma cardinal es la disfagia que se acompaña de dolor torácico intermitente y pseudo-regurgitación. Su diagnóstico de certeza lo aporta un clásico esófago-grama y hallazgos manométricos típicos, siendo la relajación incompleta del EEI un elemento imprescindible. Su manejo busca paliar la disfagia y se basa en procedimientos endoscópicos o quirúrgicos para reducir el efecto obstructivo que causa la anomalía del EEI. Las terapias de dilatación endoscópica, miotomía endoscópica y quirúrgica están en permanente evolución para brindar la mayor eficacia y seguridad en el manejo de la acalasia, causando la menor tasa de efectos colaterales como el RGE. De estas terapias, la miotomía quirúrgica es la única que muestra buenos resultados sostenidos en el largo plazo, pero surge la inquietud de la aparición de complicaciones tardías como reflujo gastroesofágico grave, esófago de Barrett y carcinoma esofágico.

Achalasia in Korea: An Epidemiologic Study Using a National Healthcare Database

Owing to the rarity of the disease, epidemiologic information on achalasia is limited. This study aimed to investigate the epidemiology and treatment patterns of achalasia in the population of Korea using a national healthcare database. The diagnostic code K22.0 of the International Classification of Diseases was used to identify cases of achalasia between 2007 and 2011. Treatment modalities for achalasia were identified using the electronic data interchange codes Q7642 or Q7641 for balloon dilation and QA421 or QA422 for esophago-cardiomyotomy. A total of 3,105 patients with achalasia (1,447 men; mean age, 52.5 yr) were identified between 2007 and 2011, indicating a prevalence of 6.29/100,000 (95% confidence interval [CI], 4.94-7.66) during this 5-yr period. A total of 191 incident cases of achalasia (82 men; mean age, 49.5 yr), which were not diagnosed as achalasia in the previous 4 yr, were detected in 2011, indicating an incidence of 0.39/100,000 (95% CI, 0.15-0.63) for that year. During the study period, balloon dilation therapy was performed a total of 975 times in 719 patients, and surgical esophago-cardiomyotomy was performed once per patient in 17 patients. This is the first population-based epidemiologic study of achalasia in Korea.

Long-term outcomes of balloon dilation versus botulinum toxin injection in patients with primary achalasia

BACKGROUND/AIMS: We compared the long-term outcomes of balloon dilation versus botulinum toxin injection in Korean patients with primary achalasia and identified factors predicting remission. METHODS: We included 73 patients with achalasia newly diagnosed between January 1988 and January 2011. We ultimately enrolled 37 of 55 patients with primary achalasia through telephone interviews, who were observed for over 1 year. Short-term outcomes were evaluated from the medical records based on symptom relief after 1 month of treatment. Long-term outcomes were evaluated in a telephone interview using a questionnaire. RESULTS: Twenty-five patients were administered a botulinum toxin injection and 12 underwent balloon dilation. One month after the botulinum toxin injection, improvements were seen in chest pain (14 [56.0%] to 4 patients [16.0%]), regurgitation (16 [64.0%] to 4 [16.0%]), and dysphagia (25 [100.0%] to 5 [20.0%]). In the balloon dilation group, chest pain (8 [66.7%] to 1 [8.3%]), regurgitation (11 [91.7%] to 1 [8.3%]), and dysphagia (12 [100.0%] to 1 [8.3%]) had improved. A significant difference was observed in the mean remission duration between the botulinum toxin injection and balloon dilation groups (13 months [range, 1 to 70] vs. 29 months [range, 6 to 72], respectively; p = 0.036). Independent factors predicting long-term remission included treatment type (odds ratio [OR], 6.982; p = 0.036) and the difference in the lower esophageal sphincter pressure (OR, 7.198; p = 0.012). CONCLUSIONS: Balloon dilation may be more efficacious than botulinum toxin for providing long-term remission in Korean patients with achalasia. Follow-up manometry may predict the long-term outcome.

Are the Outcomes of Treatment Different among the Monometric Subtypes of Achalasia? / 대한소화기학회지

No abstract available.

Esofagectomía transhiatal videoasistida en la acalasia esofágica / Videoassisted transhiatal esophagectomy for treatment of esophageal achalasia

En ocasiones la acalasia esofágica necesita de una esofagogastrectomía, de ahÍ que se elija la vía transhiatal, de preferencia la realizada por mínimo acceso y con el empleo de un flebo-extractor. El objetivo de nuestro trabajo es valorar el empleo de un flebo-extractor como sustituto de la disección esofágica transhiatal mínimamente invasiva, en una paciente con acalasia esofágica. Se realizó este abordaje en una enferma de 37 años con disfagia, dilatación esofágica importante y desnutrición proteico-energética, después de ser operada en 2 ocasiones de esofagomiotomía mínimamente invasiva, por una acalasia esofágica. La cirugía duró 4 horas, sin complicaciones y con una estadía de 4 días. La esofagectomía transhiatal mínimamente invasiva, en algunos enfermos con acalasia, tiene todos los beneficios del mínimo acceso, y con el empleo de un flebo- extractor, se agiliza el proceder de forma segura(AU)

Esophageal achalasia occasionally requires esophagogastrectomy, hence the transhiatal way is selected, preferably using minimal access and fleboextractor. The objective of this paper is to assess the use of fleboextractor as a replacement of minimally invasive transhiatal esophageal dissection in a patient with esophageal achalasia. This procedure was performed in a 37 years-old patient with disphagia, major esophageal dilation and protein-energetic undernourishment, who had been operated on twice from esophageal achalasia by using minimally invasive esophagomyotomy. The operation lasted 4 hours, without further complications and 4 day-length of stay at hospital. The minimally invasive transhiatal esophagectomy carries all the advantages of the minimum access procedure for some patients with achalasia, and the use of a fleboextractor can speed up the surgical procedure in a safe way(AU)

Allgrove (AAA) Syndrome.

This is the first reported case of Allgrove Syndrome in Paediatric Department, S. C. B. MCH in a six years old male child who presented with convulsion and altered sensorium. He had no tears since birth, dysphagia with regurgitation of food and later developed skin hyperpigmentation. Allgrove syndrome is a rare autosomal recessive syndrome characterized by progressive loss of cholinergic function resulting in alacrimia, achalasia cardia, addison’s disease and autonomic neuropathy. Early diagnosis will lead to significant reduction of morbidity and mortality which is usually due to unrecognized adrenal crisis.

Megaesophagus in the pediatric age group: a diagnostic dilemma

A 5-year-old boy weighing 8 kg presented with recurrent pulmonary infections, occasional nonbilious vomiting, intermittent cough, and failure to thrive since birth. On physical examination, vital signs were normal, but on auscultation left-sided fine crackles were found. The child was anemic, other blood biochemistry levels were within the normal range. A chest X-ray and computed tomography [CT] revealed bronchiectasis localized to the left hemithorax and a radiolucent air column within a distended esophagus. Other causes of chronic pulmonary diseases, such as cystic fibrosis, congenital immune deficiencies and primary ciliary dyskinesia were excluded. A barium swallow demonstrated a dilated esophagus with an air-fluid level and sudden narrowing at the distal end [Figure 1]. Esophageal manometry showed uncoordinated, low-amplitude peristalsis of the esophageal body and the lower sphincter pressure was normal

Acalasia esofágica / Esophageal achalasia

La acalasia es una patología de baja frecuencia que afecta la motilidad esofágica producto de la denervación mientérica del esófago y también, en gran proporción de casos, de estómago. Sus causas permanecen aún poco esclarecidas y su diagnóstico sigue siendo tardío, reportándose un desfase de al menos 5 años desde el inicio de la sintomatología, confundiéndose muchas veces con patologías como la enfermedad por reflujo gastroesofágico, entre otras. Es por ello, que requiere un alto índice de sospecha y un estudio acabado, siendo la manometría esofágica el estándar de oro. El tratamiento no es curativo en la actualidad, y está centrado en el alivio de los síntomas. Las alternativas quirúrgicas que se disponen son, la miotomía de Heller, dilatación endoscópica, y la más reciente miotomía endoscópica peroral (POEM). El tratamiento médico no ha demostrado buenos resultados y hoy en día presenta restringidas indicaciones.

Achalasia is a rare disease that affects esophageal motility as result of myenteric denervation of the esophagus and in a large proportion of cases, stomach. Its causes remain still poorly elucidated and its diagnosis remains late, reporting a delay of at least 5 years from the onset of symptoms, often confused with conditions such as gastroesophageal reflux disease, among others. Therefore, it requires a high index of suspicion and a comprehensive study, being esophageal manometry the gold standard. There is no curative treatment today and is focused on the relief of symptoms. The surgical available options are, Heller myotomy, endoscopic dilation, and the most recent peroral endoscopic myotomy (POEM). Medical treatment has not proved successful and today has restricted indications.

The correlation of esophageal body length with measure of external body parameters / Correlación de la longitud del cuerpo esofágico con medida de parámetros corporales externos

There is disagreement as to whether there is a correlation between esophageal body length and that of various measurable external body parameters. This length has also been noted to vary in various disease states of the upper gastrointestinal tract and among various races. To our knowledge no such study has been published amongst an African population and Kenyans in particular. The purpose of this study was to determine how the length of the esophagus correlates with various external body parameters. This was a cross-sectional observational study at the endoscopy unit of Kenyatta National Hospital (KNH). All consenting patients undergoing upper gastrointestinal endoscopy (OGD) at KNH. 76 subjects undergoing flexible esophagoscopy were evaluated. 43 were male. The mean esophageal length was 22.2 cm (SD 2.63). Males had a longer esophagus than women. The esophageal length had a negative correlation with weight of individual and body mass index. There was a positive correlation between esophageal length versus height of the individual and the sternal length. Individual's height is the parameter that best correlates with the esophageal body length.

Hay desacuerdo en cuanto a si existe una correlación entre la longitud del cuerpo esofágico y la de varios parámetros corporales externos medibles. Esta longitud se ha observado que varía en diferentes estados de enfermedades del tracto gastrointestinal superior y entre distintas razas. Según la literatura consultada, ningún estudio de este tipo se ha publicado, en particular, entre una población de África y Kenia. El propósito de este estudio fue determinar cómo la longitud del esófago se correlaciona con diversos parámetros corporales externos. Se realizó un estudio observacional y transversal en la Unidad de Endoscopía del Hospital Nacional Kenyatta (KNH). Todos los pacientes sometidos consintieron a la la endoscopía digestiva alta (OGD) en KNH. Fueron evaluados76 pacientes sometidos a endoscopía flexible. (43 eran hombres). La longitud promedio del esófago fue de 22,2 cm (DE 2,63). Los hombres tuvieron un esófago más largo que las mujeres. La longitud del esófago tuvo una correlación negativa con el peso del individuo y su índice de masa corporal. Hubo una correlación positiva entre la longitud del esófago en comparación con la altura de la persona y la longitud esternal. La altura individual es el parámetro que mejor se correlaciona con la longitud del cuerpo esofágico.

Achalasia in the elderly patient: a comparative study / Acalásia no idoso: um estudo comparativo

CONTEXT: Achalasia is a primary esophageal motor disorder secondary to the degeneration of ganglion cells of the inhibitory intramural myenteric plexus. It affects both sexes similarly and has two peaks of incidence, one in the 3rd to 4th decades of life and the other after 60 years of age. The effect of age on esophageal motility of patients with achalasia is not well known. Studies have shown that healthy older people, when compared to the young, have: a) a lower number of ganglion cells in the intramural myenteric plexus; b) a reduced normal relaxation of the lower esophageal sphincter; and c) a reduced esophageal peristalsis. Thus, as both age and achalasia can produce comparable degenerative changes in the intramural myenteric plexus, it is possible that advanced age could be an important factor in enhancing the clinical and manometric abnormalities commonly found in patients with achalasia. OBJECTIVES: To compare the clinical, radiological and manometric findings in young as compared to elderly (>60 years old) achalasia patients. METHODS: A retrospective study of a group of patients with untreated achalasia separated into young and elderly patients. Demographic, clinical, serology for Chagas' disease, radiological and manometric data were compared between these groups. The level of significance was P<0.05. RESULTS: The study included 105 patients, 52 young (25 M/27 F, mean age 40 years old) and 53 elderly (21 M/32 F, mean age 70 years old). The elderly group had a higher prevalence of Chagas' disease (P = 0.004) and a lower pressure of the lower esophageal sphincter [26.4 mm Hg vs 31.9 mm Hg] P = 0.001, a difference that persisted when analyzed only elderly and young patients with idiopathic achalasia. Younger patients had a higher prevalence of heartburn (P = 0.001) and chest pain (P = 0.012) than the elderly. CONCLUSION: Elderly patients with achalasia had a lower esophageal sphincter pressure than the young, even when we excluded patients with Chagas' disease but, as a group, they were less symptomatic.

CONTEXTO: Acalásia é um distúrbio motor primário do esôfago, secundário à degeneração das células ganglionares do plexo mioentérico inibitório intramural. Afeta ambos os sexos da mesma forma e tem dois picos de incidência: um na 3ª e 4ª décadas de vida e outro após os 60 anos de idade. O efeito da idade na motilidade esofagiana em pacientes com acalásia não é bem conhecido. Estudos têm demonstrado que os idosos saudáveis quando comparados aos jovens apresentam: a) menor número de células ganglionares no plexo mioentérico intramural, b) redução no número de relaxamentos normais do esfíncter esofagiano inferior, e c) redução do peristaltismo esofagiano. Assim, se tanto a idade quanto a acalásia podem acarretar alterações degenerativas do plexo mioentérico intramural, é possível que a idade avançada possa ser fator importante no aumento das anormalidades clínicas e manométricas, comumente encontradas nos pacientes com acalásia. OBJETIVOS: Comparar os achados clínicos, radiológicos e manométricos dos pacientes jovens com acalásia (<60 anos), em relação aos pacientes idosos (>60 anos). MÉTODOS: Foi realizado estudo retrospectivo de um grupo de pacientes com acalásia não tratada, separando-os em pacientes jovens e idosos. Dados demográficos, clínicos, de sorologia para doença de Chagas, radiológicos e manométricos foram comparados entre os dois grupos. O nível de significância considerado foi P<0.05. RESULTADOS: O estudo incluiu 105 pacientes, 52 jovens (25 H/27 M, média de idade de 40 anos) e 53 idosos (21 H, 32 M, média de idade de 70 anos). O grupo idoso apresentou elevada prevalência de doença de Chagas (P = 0.004) e menor pressão do esfíncter esofagiano inferior [26,4 mm Hg x 31,9 mm Hg) P = 0.001, diferença esta que persistiu mesmo quando se analisou apenas os pacientes idosos e jovens com acalásia idiopática. Os pacientes jovens apresentaram elevada prevalência de pirose (P = 0.001) e dor torácica (P = 0.012), quando comparados aos idosos. CONCLUSÃO: Os pacientes idosos com acalásia apresentaram pressão do esfíncter esofagiano inferior mais baixa do que os jovens, mesmo quando excluídos com acalásia chagásica, entretanto como grupo eles foram menos sintomáticos.

Demographic, clinical features and treatment outcomes in 700 achalasia patients in Iran

Achalasia is the most recognized motor disorder of the esophagus. Because it is an uncommon disease, most studies have reviewed small numbers of patients. Here, we report demographic, clinical features and treatment outcomes in 700 achalasia patients. In all patients, diagnosis was established based on clinical, radiological, endoscopic and manometric criteria. A questionnaire was completed for each patient and included the patient's age, gender, initial symptoms, frequency of different symptoms, presence of positive family history for achalasia, other accompanying diseases and treatment outcomes. In our study men were affected more than women [54.3% vs. 45.7%]. Patients' mean age was about 38 years. The most frequent symptoms noted were: dysphagia to solids and liquids, active regurgitation, passive regurgitation and weight loss, respectively. Women complained of chest pain more than men [59% vs. 47.1%, p=0.04]. The vast majority of our patients were treated by pneumatic dilation [PD] of the LES and in long-term follow-up, 67% were in the responder group. Females responded better than males to PD. Dysphagia to solids is the most common symptom in patients with achalasia. Chest pain was significantly higher among women. PD is an effective treatment for achalasia with long-term efficacy in the majority of patients

Cirugía robótica en el tratamiento quirúrgico de la acalasia: primera experiencia en el Hospital Universitario de Caracas / Robotic surgery in the treatment of achalasia: first experience at the Hospital Universitario of Caracas

Reportar la experiencia inicial en el tratamiento quirúrgico de la acalasia asistido por robot en el Hospital Universitario de Caracas. Paciente masculino de 62 años de edad quien consultó por presentar disfagia de 6 meses de evolución, la endoscopia digestiva superior no mostró hallazgos patológicos, se realizó manometria donde se observó alteración del periltastismo y falta de relajación del esfínter esofágico inferior confirmándose el diagnóstico de acalasia. Se decide realizar tratamiento quirúrgico dentro del marco del programa de Cirugía Robótica del Hospital Universitario de Caracas. El paciente es llevado a mesa operatoria, donde se realizó miotomia de Heller y funduplicatura tipo Dor por vía laparoscópica asistida por robot, en un tiempo operatorio de165 minutos, sin complicaciones asociadas al procedimiento. El paciente es egresado satisfactoriamente a las 24 horas. El tratamiento quirúrgico mínimamente invasivo de la acalasia asistido por robot, es un procedimiento seguro y factible, que parece aportar ciertas ventajas sobre la cirugía laparoscópica convencional.

To report the initial experience in robot assisted laparoscopic treatment of achalasia in the University Hospital of Caracas. Sixty two years old male patients who presented a 6 months history of dysphagia. The superior endoscopic study was normal and the esophageal manometry showed alteration in peristaltism with absent inferior esophageal sphincter relaxation, confirming the diagnosis of achalasia. The patient is referred to the robotic surgery program of the Hospital Universitario of Caracas. A robot assisted laparoscopic treatment of achalasia was performed. The operative time was 165 minutes, with no procedure associated complication reported. The patient was dischange 24 hours after intervention. The robot assited minimally invasive surgical treatment of the achalasia is a safe and effective procedure which apparently show some advantanges over traditional laparoscopy.

Autoimmune thyrotoxicosis with achalasia cardia.

We report a case of autoimmune thyrotoxocosis in an 11-year-old boy with achalasia cardia. This case explores autoimmunity as an etiological factor for achalasia based on several autoimmune conditions that have been associated with it.

Caracterización de pacientes con acalasia en el nivel secundario de atención / Characterization of patients with achalasia in the second level care

Se realizó uno estudio descriptivo, prospectivo y transversal en 31 pacientes con diagnóstico de acalasia, atendidos en el Servicio de Gastroenterología del Hospital General Docente Dr Juan Bruno Zayas Alfonso de Santiago de Cuba desde julio del 2006 hasta septiembre del 2007. Entre los principales resultados sobresalieron el predominio del sexo femenino, de los hábitos tóxicos como factores de riesgo, de la hernia hiatal y de la disfagia, así como la pérdida de peso. Se utilizó el porcentaje como medida de resumen y la prueba del Ji al cuadrado en aquellas tablas donde hubo condiciones para su aplicación, considerando su significación cuando p< 0,05.

A descriptive, prospective and cross-sectional study was carried out in 31 patients with diagnosis of achalasia, assisted in the Service of Gastroenterology of Dr Juan Bruno Zayas Alfonso Teaching General Hospital of Santiago de Cuba from July, 2006 to September, 2007. Among the main results the most important were the prevalence of the female sex, of toxic habits as risk factors, of hiatal hernia and of dysphagia, as well as the loss of weight. The percentage was used as summary measure and the X2 test in those charts where there were conditions for their application, taking into account their significance when p 0,05.