[Achalasia: a review of western and iranian experiences and studies]

Achalasia is a primary motor disorder of the esophagus, in which esophageal emptying is impaired. Diagnosis of achalasia is based on clinical findings and confirmed by radiologic, endoscopic and manometric evaluations. Several treatments for achalasia have been introduced. We searched the Pubmed Database for original articles and meta-analyses about achalasia to summarize the current knowledge regarding this disease, with particular focus on different procedures utilized for treatment. We also report the Iranian experience of treatment of this disease, since it could be considered as a model for medium-resource countries. Laparoscopic myotomy with fundoplication is the best surgical method for treatment of achalasia with its high success rate and therapeutic response. Compared to other treatments, however, the initial cost of myotomy is usually higher and the recovery period is longer. Graded pneumatic dilation with a slow rate of balloon inflation seems to be an effective and safe initial alternative. Injection of botulinum toxin into the lower esophageal sphincter before pneumatic dilation may increase remission rates. However, this needs to be confirmed in further studies. Due to the lack of adequate information regarding the role of expandable stents in the treatment of achalasia, insertion of stents does not currently seem to be a recommended treatment. In summary, laparoscopic myotomy can be considered as the procedure of choice for surgical treatment of achalasia. Graded pneumatic dilation is an effective alternative and can be recommended as a first therapeutic option in the majority of achalasia patients

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

[Multiple esophageal diverticules in a case of nutcracker esophagus]

Multiple esophageal diverticula is a rare entity that may be seen in the course of esophageal motor disorders. Herein, I reported a 45 year-old man presented with intermittent chest pain and dysphagia since 20 years ago that exaggerated during the last six months. Barium swallow and upper GI endoscopy revealed multiple diverticula along the esophagus and his esophageal manometry showed high amplitude contractions [>180 mmHg] in distal part of the esophagus that confirmed the diagnosis of nutcracker esophagus

Prevalence of helicobacter pylori in two Iranian provinces with high and low incidence of gastric carcinoma

Gastric cancer is significantly more prevalent in north western than central Iran. Growing evidence has related Helicobacter pylori [HP] to gastric cancer worldwide. We assessed the prevalence of HP infection in high [Ardebil] and low [Yazd] prevalence gastric cancer provinces of Iran. Cluster sampling of healthy population aged less than 20 years was performed in Ardebil and Yazd provinces over a 2 month period. Five ml blood was drawn from each person and HP IgG was tested using ELISA [Diagnostic Corporation., sensitivity 98%, specificity 96%]. Seven hundred and eleven individuals [358 in Ardebil and 353 in Yazd] were enrolled. One hundred and seventy individuals [47.5%] in Ardebil and 108 individuals [30.6%] in Yazd were positive for HP [P<0.0001]. Logistic regression analysis showed that no other factor except for increasing age is associated with increased H. Pylori infection in either area. HP infection is significantly more prevalent amongst individuals less than 20 years of age in areas with high prevalence of gastric cancer in Iran. Our data suggest a relation between HP infection and gastric cancer in Iran