891:
915:
for the occurrence of reflux following myotomy. The gastroesophageal valve is the result of infolding of the esophagus into the stomach at the esophageal hiatus. This infolding creates a valve that extends from 7 o'clock to 4 o'clock (270 degrees) around the circumference of the esophagus. Laparoscopic myotomy cuts the muscle at the 12 o'clock position, resulting in incompetence of the valve and reflux. Recent
848:(Botox) may be injected into the lower esophageal sphincter to paralyze the muscles holding it shut. As in the case of cosmetic Botox, the effect is only temporary and lasts about 6 months. Botox injections cause scarring in the sphincter which may increase the difficulty of later Heller myotomy. This therapy is recommended only for patients who cannot risk surgery, such as elderly people in poor health.
450:. If enough food builds up, it triggers a need to purge what was swallowed, often described as not being accompanied with nausea per se, but an intense and sometimes uncontrollable need to vomit what was built up in the esophagus that, due to the excessive stretching of the esophageal walls, is easily released without heaving. This cycle is so that little to practically no food reaches the
487:
446:). Untreated, mid-stage achalasia can fully obstruct the passage of almost any food or liquid β the greater surface area of the swallowed object often being more difficult to pass the LES/LOS (lower esophageal sphincter). At such a stage, upon swallowing food, it entirely remains in the esophagus, building up and stretching it to an extreme size in a phenomenon known as
692:
51:
596:
652:
466:, and death, the final of which may not always be listed as "death by achalasia", contributing to the already inaccurate or inconclusive count of deaths caused by the disease, not to mention the variable of other medical factors that could accelerate death of an achalasia patient's already weakened body.
869:
occurs after pneumatic dilatation in many patients. Pneumatic dilatation is most effective in the long-term on patients over the age of 40; the benefits tend to be shorter-lived in younger patients due to the body's higher rate of recovery from trauma, often resulting in repeat procedures with larger
494:
A review of the literature shows similar results with good symptom control reported in 75β100% of patients undergoing such a procedure. However, oesophagectomy is not without risk, and every patient must be fully informed of all associated risks. Reported mortality rates of 5β10% are described, while
940:
Patients usually spend about 1β4 days in the hospital and are discharged after satisfactory examinations. Patients are discharged on full diet and generally able to return to work and full activity immediately upon discharge. Major complications are rare after POEM and are generally managed without
914:
The shortcoming of laparoscopic esophageal myotomy is the need for a fundoplication. On the one hand, the myotomy opens the esophagus, while on the other hand, the fundoplication causes an obstruction. Recent understanding of the gastroesophageal antireflux barrier/valve has shed light on the reason
1022:
In 1937, F.C. Lendram affirmed the conclusions of Hurt and Rake, forwarding the term achalasia over cardiospasm. (Hard to say who really changed the name between the last two entries) In 1937, the physician F.C. Lendram affirmed the conclusions of Hurt and Rake in 1929, forwarding the usage of the
919:
laparoscopic series have attempted a myotomy at the 5 o'clock position on the esophagus away from the valve. The robotic lateral esophageal myotomy preserves the esophageal valve and does not result in reflux, thereby obviating the need for a fundoplication. The robotic lateral esophageal myotomy
902:
or "wrap", where the fundus (Part of the stomach which hangs above the connection to the oesophagus) is wrapped around said lower oesophagus and sewn to itself, secured to the diaphragm to create pressure on the sphincter post-myotomy, is generally added in order to prevent excessive reflux, which
864:
or dilatation, the muscle fibers are stretched and slightly torn by forceful inflation of a balloon placed inside the lower esophageal sphincter. There is always a small risk of a perforation which requires immediate surgical repair. Pneumatic dilatation causes some scarring which may increase the
886:
or laparoscopically. The myotomy is a lengthwise cut along the esophagus, starting above the LES and extending down 1 to 2 cm onto the gastric cardia. The esophagus is made of several layers, and the myotomy cuts only through the outside muscle layers which are squeezing it shut, leaving the
936:
that follows the same principle as the Heller myotomy. A tiny incision is made on the esophageal mucosa through which an endoscope is inserted. The innermost circular muscle layer of the esophagus is divided and extended through the LES until about 2 cm into the gastric muscle. Since this
796:
Both before and after treatment, achalasia patients may need to eat slowly, chew very well, drink plenty of water with meals, and avoid eating near bedtime. Raising the head off the bed or sleeping with a wedge pillow promotes emptying of the esophagus by gravity. After surgery or pneumatic
482:
End stage disease, characterised by a markedly dilated and tortuous "burned-out" esophagus and recurrent obstructive symptoms, may require oesophageal resection in order to restore gastro-intestinal function, reverse nutritional deficits and reduce the risk of aspiration pneumonia.
683:(enlarged) to varying degrees as the esophagus is gradually stretched over time. An air-fluid margin is often seen over the barium column due to the lack of peristalsis. A five-minutes timed barium swallow can provide a useful benchmark to measure the effectiveness of treatment.
2985:
2970:
956:
Even after successful treatment of achalasia, swallowing may still deteriorate over time. The esophagus should be checked every year or two with a timed barium swallow because some may need pneumatic dilatations, a repeat myotomy, or even
474:
End-stage achalasia, typified by a massively dilated and tortuous oesophagus, may occur in patients previously treated but where further dilatation or myotomy fails to relieve dysphagia or prevent nutritional deterioration, and
805:
secretion, and foods that can aggravate reflux, including ketchup, citrus, chocolate, alcohol, and caffeine, may need to be avoided. If untreated or particularly aggressive, irritation and corrosion caused by acids can lead to
2392:
Rebecchi F, Giaccone C, Farinella E, Campaci R, Morino M (December 2008). "Randomized controlled trial of laparoscopic Heller myotomy plus Dor fundoplication versus Nissen fundoplication for achalasia: long-term results".
2032:
DΓΆhla M, Leichauer K, Gockel I, Niebisch S, Thieme R, Lundell L, et al. (March 2019). "Characterization of esophageal inflammation in patients with achalasia. A retrospective immunohistochemical study".
1137:
Tanaka S, Abe H, Sato H, Shiwaku H, Minami H, Sato C, et al. (October 2021). "Frequency and clinical characteristics of special types of achalasia in Japan: A large-scale, multicenter database study".
499:
leak in 10β20% of patients. Patients must also be informed of longer-term complications. Anastomotic stricture has been reported in up to 50% of patients, depending on length of post-operative follow-up.
907:
for several weeks to a month, avoiding foods that can aggravate reflux. The most recommended fundoplication to complement Heller myotomy is Dor fundoplication, which consists of a 180- to 200-degree
719:
in different parts of the esophagus during the act of swallowing. Manometry reveals failure of the LES to relax with swallowing and lack of functional peristalsis in the smooth muscle esophagus.
146:
Anorexia (but willing and trying to eat), inability to swallow food, chest pain comparable to heart attack, lightheadedness, dehydration, excessive vomiting after eating (often without nausea).
3102:
2748:
Mardani J, Lundell L, EngstrΓΆm C (May 2011). "Total or posterior partial fundoplication in the treatment of GERD: results of a randomized trial after 2 decades of follow-up".
911:
wrap around the esophagus. It provides excellent results as compared to Nissen's fundoplication, which is associated with higher incidence of postoperative dysphagia.
2933:
933:
948:
POEM has been performed on over 1,200 patients in Japan and is becoming increasingly popular internationally as a first-line therapy in patients with achalasia.
504:, reported in up to 20% of patients, tends to be self-limiting and may be managed medically if necessary, and vagal-sparing oesophagectomy may reduce this risk.
780:
provided greater benefit than either botulinum toxin or dilation in those who fail medical management. However, a recent randomized controlled trial found
3116:
285:
from coming back up. A fully understood cause to the disease is unknown, as are factors that increase the risk of its appearance. Suggestions of a
2436:
Inoue H, Minami H, Kobayashi Y, Sato Y, Kaga M, Suzuki M, et al. (April 2010). "Peroral endoscopic myotomy (POEM) for esophageal achalasia".
1015:
In 1929, two physicians β Hurt and Rake β figured out that the problem was due to the LES not relaxing. They named the disease achalasia, meaning
434:
when lying in a horizontal position. The chest pain experienced, also known as cardiospasm and non-cardiac chest pain can often be mistaken for a
870:
balloons to achieve maximum effectiveness. After multiple failures using pneumatic dilation, surgeries such as the more consistently successful
1090:
Incidence of achalasia has risen to approximately 1.6 per 100,000 in some populations. Disease affects mostly adults between ages 30s and 50s.
1057:
partial fundoplication, acting as a solution to the intense post-surgery GERD, and risk of stomach acid inhalation accompanying Heller myotomy.
667:(X-ray recording) to observe the flow of the fluid through the esophagus. Normal peristaltic movement of the esophagus is not seen. There is
2732:
2016:
2479:
Inoue H, Sato H, Ikeda H, Onimaru M, Sato C, Minami H, et al. (August 2015). "Per-Oral
Endoscopic Myotomy: A Series of 500 Patients".
385:. Achalasia affects about one person in 100,000 per year. There is no gender predominance for the occurrence of disease. The term is from
3000:
1081:, was devised by H. Inoue in Tokyo, Japan. This method is currently considered experimental in many countries such as the United States.
762:, a network of nerve fibers that controls esophageal peristalsis. It is not possible to diagnose achalasia by means of biopsy alone.
192:
Inconclusive, but possibly: history of autoimmune disorders, air-hunger that accompanies anxiety, faulty eating habits, improper diet
490:
Transhiatal oesophagectomy specimen from a patient with late-stage achalasia. Diverticulum at the left lower end of the oesophagus.
1529:
Gockel HR, Schumacher J, Gockel I, Lang H, Haaf T, NΓΆthen MM (October 2010). "Achalasia: will genetic studies provide insights?".
635:, is typically performed to rule out the possibility of cancer. The internal tissue of the esophagus generally appears normal in
430:. Dysphagia tends to become progressively worse over time and to involve both fluids and solids. Some people may also experience
281:. The lower esophageal sphincter is a muscle between the esophagus and stomach that opens when food comes in. It closes to avoid
866:
604:
1008:
In 1913, Ernest Heller became the first person to successfully perform an esophagomyotomy, now known in his namesake as the
776:
significantly improves outcomes in 75% of people with mild or moderate disease. It was classically considered that surgical
525:
1122:
567:, loss of ganglion cells, and neurofibrosis; these events appear to occur early in achalasia. Thus, it seems there is an
3132:
2791:
312:
of the esophagus (inability of smooth muscle to move food down the esophagus) in the absence of other explanations like
293:
270:
1078:
929:
359:
715:(thin tube) is inserted through the nose, and the patient is instructed to swallow several times. The probe measures
672:
640:
628:
305:
262:
3107:
2079:
Wang L, Li YM, Li L (November 2009). "Meta-analysis of randomized and controlled treatment trials for achalasia".
751:, the removal of a tissue sample during endoscopy, is not typically necessary in achalasia but if performed shows
1106:
has achalasia, bearing symptoms that sometimes occur during official engagements, in particular lightheadedness.
708:
415:
328:
278:
512:
The cause of most cases of achalasia is unknown. LES pressure and relaxation are regulated by excitatory (e.g.,
3011:
937:
procedure is performed entirely through the patient's mouth, there are no visible scars on the patient's body.
819:
699:
contractions, increased intraesophageal pressure, and failure of relaxation of the lower esophageal sphincter.
556:
365:
The most common form is primary achalasia, which has no known underlying cause. It is due to the failure of
2122:
Boeckxstaens GE, Annese V, des
Varannes SB, Chaussade S, Costantini M, Cuttitta A, et al. (May 2011).
966:
807:
798:
399:
2310:
Sharp, Kenneth W.; Khaitan, Leena; Scholz, Stefan; Holzman, Michael D.; Richards, William O. (May 2002).
1181:
Mayberry JF, Newcombe RG, Atkinson M (April 1988). "An international study of mortality from achalasia".
1043:
1005:
described the disease as cardiospasm, and felt it was a functional problem rather than a mechanical one.
899:
890:
861:
781:
680:
632:
486:
351:
2222:"Endoscopic pneumatic dilation versus botulinum toxin injection in the management of primary achalasia"
2181:
1601:"Oesophagectomy in the management of end-stage achalasia β case reports and a review of the literature"
1039:
1002:
990:
first described the condition now known as achalasia and treated the problem with a dilation using a
970:
883:
849:
831:
730:
704:
620:
443:
346:
studies. Various treatments are available, although none cures the condition. Certain medications or
336:
134:
2989:
2672:
Nissen R (October 1961). "Gastropexy and "fundoplication" in surgical treatment of hiatal hernia".
1222:
Park W, Vaezi MF (June 2005). "Etiology and pathogenesis of achalasia: the current understanding".
716:
679:, producing a "bird's beak" or "rat's tail" appearance. The esophagus above the narrowing is often
2773:
2697:
2586:
2461:
2418:
2269:
Deb S, Deschamps C, Allen MS, Nichols FC, Cassivi SD, Crownhart BS, Pairolero PC (October 2005).
2163:
2104:
2058:
1921:
1706:
1554:
1470:
1247:
1163:
459:
297:
141:
1847:
Banki F, Mason RJ, DeMeester SR, Hagen JA, Balaji NS, Crookes PF, et al. (September 2002).
1102:
had achalasia from the age of 18. The
Zambian government announced that the President of Zambia
58:
A chest X-ray showing achalasia (arrows point to the outline of the massively dilated esophagus)
2824:[Per-oral endoscopic myotomy (POEM) for 43 consecutive cases of esophageal achalasia].
2822:"[Per-oral endoscopic myotomy (POEM) for 43 consecutive cases of esophageal achalasia]"
2516:"Per-oral endoscopic myotomy, 1000 cases later: pearls, pitfalls, and practical considerations"
603:
Due to the similarity of symptoms, achalasia can be mistaken for more common disorders such as
3051:
3022:
2884:
2833:
2765:
2728:
2689:
2654:
2646:
2578:
2537:
2496:
2453:
2410:
2349:
2331:
2292:
2251:
2155:
2096:
2050:
2012:
1989:
1913:
1878:
1829:
1788:
1747:
1698:
1663:
1622:
1581:
1546:
1511:
1462:
1441:"Review article: the management of achalasia β a comparison of different treatment modalities"
1418:
1372:
1337:
1296:
1239:
1190:
1155:
903:
can cause serious damage to the esophagus over time. After surgery, patients should keep to a
576:
537:
382:
374:
197:
117:
2874:
2864:
2757:
2720:
2681:
2617:
2568:
2527:
2488:
2445:
2402:
2339:
2323:
2282:
2241:
2233:
2145:
2135:
2088:
2042:
1979:
1969:
1905:
1868:
1860:
1819:
1778:
1737:
1690:
1653:
1612:
1538:
1501:
1452:
1410:
1364:
1327:
1286:
1278:
1231:
1147:
941:
intervention. Long term patient satisfaction is similar following POEM compared to standard
759:
668:
548:
501:
286:
126:
122:
71:
1640:
Banbury MK, Rice TW, Goldblum JR, Clark SB, Baker ME, Richter JE, et al. (June 1999).
1401:
Spiess AE, Kahrilas PJ (August 1998). "Treating achalasia: from whalebone to laparoscope".
3097:
2906:
845:
729:
Pressure of LES <26 mm Hg is normal, >100 is considered achalasia, > 200 is
451:
347:
130:
1939:
308:(LES). It is characterized by incomplete LES relaxation, increased LES tone, and lack of
2637:
Nissen R (May 1956). "" [A simple operation for control of reflux esophagitis].
2246:
2221:
599:
An axial CT image showing marked dilatation of the esophagus in a person with achalasia.
2879:
2852:
2344:
2311:
1984:
1957:
1873:
1848:
1291:
1266:
1035:
1009:
871:
785:
616:
533:
378:
355:
340:
2994:
2821:
2492:
2007:
Emanuel Rubin; Fred
Gorstein; Raphael Rubin; Roland Schwarting; David Strayer (2001).
1783:
1766:
1658:
1641:
739:
Relative increase in intra-esophageal pressure as compared with intra-gastric pressure
3126:
3092:
2902:
2327:
2287:
2271:"Laparoscopic esophageal myotomy for achalasia: factors affecting functional results"
2270:
1864:
1824:
1807:
1742:
1726:"Diagnostic criteria and surgical procedure for megaesophagus--a personal experience"
1725:
1457:
1440:
1235:
1167:
987:
983:
958:
835:
726:
Lower esophageal sphincter (LES) fails to relax upon wet swallow (<75% relaxation)
656:
612:
608:
529:
513:
476:
447:
265:
to remain closed. Without a modifier, "achalasia" usually refers to achalasia of the
258:
2777:
2701:
2590:
2465:
2422:
2167:
2108:
2062:
1925:
1896:
Cheatham JG, Wong RK (June 2011). "Current approach to the treatment of achalasia".
1251:
1208:
244:
829 in a period of 1β8 years study out of a 28 demographic, 754 million record pool.
2911:
2237:
1710:
1681:
Glatz SM, Richardson JD (September 2007). "Esophagectomy for end stage achalasia".
942:
802:
639:, although a "pop" may be observed as the scope is passed through the non-relaxing
544:
521:
435:
343:
282:
3062:
2124:"Pneumatic dilation versus laparoscopic Heller's myotomy for idiopathic achalasia"
2046:
1558:
1474:
928:
A new endoscopic therapy for achalasia management was developed in 2008 in Japan.
882:
Heller myotomy helps 90% of achalasia patients. It can usually be performed by a
571:
context to achalasia, most likely caused by viral triggers. Other studies suggest
3016:
2853:"Achalasia: a review of clinical diagnosis, epidemiology, treatment and outcomes"
2761:
2622:
2605:
2406:
1506:
1489:
1332:
1315:
842:
and swollen feet, and these medications often stop helping after several months.
3046:
2724:
1103:
1068:
920:
has had the best results to date in terms of the ability to eat without reflux.
755:
752:
696:
664:
560:
517:
496:
455:
427:
398:
Achalasia can also manifest alongside other diseases as a rare syndrome such as
309:
289:
form of achalasia exist, but this is neither fully understood, nor agreed upon.
187:
2532:
2515:
2367:
1617:
1600:
1074:
In 1994, Paricha et al. introduces Botox as a method for reducing LES pressure.
454:
to have its nutrients be absorbed into the bloodstream, leading to progressive
3071:
2979:
2573:
2556:
2092:
1909:
1694:
1572:
Dughera L, Cassolino P, CisarΓ² F, Chiaverina M (September 2008). "Achalasia".
1542:
1099:
995:
991:
823:
773:
770:
572:
568:
564:
463:
419:
332:
3065:
2869:
2799:
2557:"Current status of achalasia management: a review on diagnosis and treatment"
2335:
1974:
373:. However, a small proportion occurs secondary to other conditions, such as
228:~76% chance of survival after 20 years (in a western country such as Germany)
3076:
3057:
3027:
2658:
1944:
904:
636:
624:
584:
411:
324:
301:
266:
223:
2888:
2837:
2769:
2693:
2650:
2582:
2541:
2500:
2457:
2449:
2414:
2353:
2296:
2255:
2195:
2159:
2100:
2054:
1993:
1917:
1882:
1792:
1751:
1702:
1667:
1626:
1585:
1550:
1515:
1466:
1414:
1376:
1368:
1341:
1300:
1243:
1159:
691:
438:. It can be extremely painful in some patients. Food and liquid, including
172:
2nd stage β 4β5 cm dilated, bird beak looking, 3rd stage β 5β7 cm, dilated
50:
2140:
2123:
1833:
1422:
1194:
2150:
1282:
908:
839:
827:
712:
580:
317:
17:
1767:"Esophagectomy for achalasia: patient selection and clinical experience"
595:
218:
Heller myotomy and fundoplomy, POEM, pneumatic dilation, botulinum toxin
2685:
1355:
Pandolfino JE, Gawron AJ (May 2015). "Achalasia: a systematic review".
916:
777:
423:
370:
2962:
2934:"Zambia: President collapses from dizziness during televised ceremony"
2312:"100 Consecutive Minimally Invasive Heller Myotomies: Lessons Learned"
1151:
965:
testing and endoscopy to check for reflux damage, which may lead to a
3111:
2974:
1765:
Devaney EJ, Lannettoni MD, Orringer MB, Marshall B (September 2001).
1132:
1130:
748:
676:
439:
366:
313:
274:
1956:
Chuah SK, Hsu PI, Wu KL, Wu DC, Tai WC, Changchien CS (April 2012).
838:. However, many patients experience unpleasant side effects such as
202:
Esophageal manometry, biopsy, X-ray, barium swallow study, endoscopy
27:
Inability of the sphincter between the esophagus and stomach to open
1046:, eventually publishing the results of two cases in a 1956 copy of
442:, are retained in the esophagus and may be inhaled into the lungs (
350:
may be used in some cases, but more permanent relief is brought by
2715:
Watson DI, TΓΆrnqvist B (2016). "Anterior
Partial Fundoplication".
1316:"AGA technical review on the clinical use of esophageal manometry"
1067:
In 1991, the physician Shimi and his colleagues perform the first
1042:, performs the first fundoplomy, now known in his namesake as the
889:
690:
643:
with some difficulty, and food debris may be found above the LES.
594:
431:
44:
Achalasia cardiae, cardiospasm, esophageal aperistalsis, achalasia
1077:
In 2008, the newest method of surgically treating achalasia, the
3005:
1123:
ACHALASIA | Meaning & Definition for UK English | Lexico.com
540:. The result is a hypertensive nonrelaxed esophageal sphincter.
387:
2009:
Rubin's
Pathology β clinicopathological foundations of medicine
711:) is considered the key test for establishing the diagnosis. A
651:
552:
1849:"Vagal-sparing esophagectomy: a more physiologic alternative"
1808:"Esophageal resection for achalasia: indications and results"
865:
difficulty of Heller myotomy if the surgery is needed later.
2011:. Maryland: Lippincott Williams & Wilkins. p. 665.
962:
101:
98:
92:
83:
818:
Drugs that reduce LES pressure are useful. These include
547:
examination, shown an inflammatory response consisting of
1642:"Esophagectomy with gastric reconstruction for achalasia"
1599:
Howard JM, Ryan L, Lim KT, Reynolds JV (1 January 2011).
961:
after many years. In addition, some physicians recommend
77:
663:
The patient swallows a barium solution, with continuous
977:
History of the understanding and treatment of achalasia
2851:
O'Neill OM, Johnston BT, Coleman HG (September 2013).
2514:
Bechara R, Onimaru M, Ikeda H, Inoue H (August 2016).
1267:"Classification of oesophageal motility abnormalities"
495:
morbidity rates of up to 50% have been reported, and
95:
80:
74:
2952:
2220:
Leyden JE, Moss AC, MacMathuna P (8 December 2014).
1490:"Achalasia: update on the disease and its treatment"
801:
are required to prevent reflux damage by inhibiting
536:, causing an imbalance in excitatory and inhibitory
89:
3037:
2956:
2826:
Nihon Rinsho. Japanese
Journal of Clinical Medicine
381:(an infectious disease common in South America) or
269:. Achalasia can happen at various points along the
240:
232:
222:
214:
206:
196:
186:
178:
166:
158:
150:
140:
116:
86:
62:
40:
35:
1646:The Journal of Thoracic and Cardiovascular Surgery
894:Image of a stomach which has undergone Fundoplomy
852:has a better long term effectiveness than botox.
154:Normally in mid-to-late life, rarely during youth
3117:U.S. Society for Surgery of the Alimentary Tract
528:) neurotransmitters. People with achalasia lack
934:natural orifice transluminal endoscopic surgery
1001:In 1881, the German Polish-Austrian physician
1053:In 1962, the physician Dor reports the first
8:
1060:In 1963, the physician Toupet reports first
969:condition known as Barrett's esophagus or a
695:Schematic of manometry in achalasia showing
615:disorders. Specific tests for achalasia are
2481:Journal of the American College of Surgeons
2226:The Cochrane Database of Systematic Reviews
1314:Pandolfino JE, Kahrilas PJ (January 2005).
2953:
2674:The American Journal of Digestive Diseases
1445:Alimentary Pharmacology & Therapeutics
1140:Journal of Gastroenterology and Hepatology
758:and absence of certain nerve cells of the
49:
32:
2878:
2868:
2639:Schweizerische Medizinische Wochenschrift
2621:
2572:
2531:
2343:
2286:
2245:
2149:
2139:
1983:
1973:
1872:
1823:
1782:
1741:
1657:
1616:
1505:
1456:
1331:
1290:
627:of the esophagus, stomach, and duodenum (
174:4th / Late-stage β 8+ cm dilated, sigmoid
3101:) is being considered for deletion. See
1574:Minerva Gastroenterologica e Dietologica
1396:
1394:
1392:
1390:
1388:
1386:
1224:The American Journal of Gastroenterology
932:or POEM is a minimally invasive type of
722:Characteristic manometric findings are:
650:
485:
2074:
2072:
1806:Orringer MB, Stirling MC (March 1989).
1434:
1432:
1115:
543:Autopsy and myotomy specimens have, on
1958:"2011 update on esophageal achalasia"
1488:Francis DL, Katzka DA (August 2010).
1265:Spechler SJ, Castell DO (July 2001).
354:and surgical cleaving of the muscle (
261:fibers to relax, which can cause the
7:
2372:The Lecturio Medical Concept Library
1003:Johann Freiherr von Mikulicz-Radecki
2820:Inoue H, Kudo SE (September 2010).
2128:The New England Journal of Medicine
1683:Journal of Gastrointestinal Surgery
1439:Lake JM, Wong RK (September 2006).
784:to be non-inferior to laparoscopic
410:The main symptoms of achalasia are
25:
3105:to help reach a consensus. βΊ
2857:World Journal of Gastroenterology
2493:10.1016/j.jamcollsurg.2015.03.057
1962:World Journal of Gastroenterology
3119:β Achalasia treatment guidelines
2555:Tuason J, Inoue H (April 2017).
2328:10.1097/00000658-200205000-00004
2288:10.1016/j.athoracsur.2005.04.008
1898:Current Gastroenterology Reports
1865:10.1097/00000658-200209000-00009
1743:10.1111/j.1442-2050.2008.00897.x
1605:International Journal of Surgery
1458:10.1111/j.1365-2036.2006.03079.x
1236:10.1111/j.1572-0241.2005.41775.x
70:
2081:Digestive Diseases and Sciences
982:In 1672, the English physician
736:Aperistalsis in esophageal body
605:gastroesophageal reflux disease
2606:"Heller of the Heller Myotomy"
2275:The Annals of Thoracic Surgery
2238:10.1002/14651858.CD005046.pub3
2182:"Barrett's Esophagus and GERD"
1812:The Annals of Thoracic Surgery
1771:The Annals of Thoracic Surgery
1034:In 1955, the German physician
867:Gastroesophageal reflux (GERD)
655:"Bird's beak" appearance and "
323:Achalasia is characterized by
253:, often referred to simply as
1:
2604:Haubrich WS (February 2006).
2047:10.1016/j.humpath.2018.11.006
1784:10.1016/S0003-4975(01)02890-9
1659:10.1016/S0022-5223(99)70243-6
986:, one of the founders of the
532:, noncholinergic, inhibitory
526:vasoactive intestinal peptide
277:, for instance, may occur in
2762:10.1097/SLA.0b013e3182171c48
2623:10.1053/j.gastro.2006.01.030
2407:10.1097/SLA.0b013e318190a776
1825:10.1016/0003-4975(89)90369-X
1507:10.1053/j.gastro.2010.06.024
1333:10.1053/j.gastro.2004.11.008
887:inner mucosal layer intact.
862:balloon (pneumatic) dilation
703:Because of its sensitivity,
414:(difficulty in swallowing),
335:. Diagnosis is reached with
294:esophageal motility disorder
170:1st stage β 2β3 cm dilated,
2907:"First reach for the stars"
2725:10.1007/978-3-319-25094-6_8
2561:Journal of Gastroenterology
1724:Lewandowski A (June 2009).
1079:per-oral endoscopic myotomy
930:Per-oral endoscopic myotomy
292:Esophageal achalasia is an
3149:
2533:10.1016/j.gie.2016.03.1469
2520:Gastrointestinal Endoscopy
1618:10.1016/j.ijsu.2010.11.010
874:can be attempted instead.
677:gastro-esophageal junction
673:lower esophageal sphincter
641:lower esophageal sphincter
629:esophagogastroduodenoscopy
306:lower esophageal sphincter
263:lower esophageal sphincter
2574:10.1007/s00535-017-1314-5
2093:10.1007/s10620-008-0637-8
1910:10.1007/s11894-011-0190-z
1730:Diseases of the Esophagus
1695:10.1007/s11605-007-0226-8
1543:10.1007/s00439-010-0874-8
709:esophageal motility study
631:or EGD), with or without
287:genetically transmittable
57:
48:
3103:templates for discussion
2870:10.3748/wjg.v19.i35.5806
1975:10.3748/wjg.v18.i14.1573
820:calcium channel blockers
659:", typical in achalasia.
520:) and inhibitory (e.g.,
479:may be the only option.
325:difficulty in swallowing
1183:Hepato-Gastroenterology
1064:partial fundoplication.
557:cytotoxic T lymphocytes
210:No method of prevention
2717:Fundoplication Surgery
2450:10.1055/s-0029-1244080
1415:10.1001/jama.280.7.638
1369:10.1001/jama.2015.2996
895:
799:proton pump inhibitors
700:
660:
600:
559:, variable numbers of
491:
400:achalasia microcephaly
369:esophageal inhibitory
279:Hirschsprung's disease
271:gastrointestinal tract
2792:"All About Achalasia"
2645:(Suppl 20): 590β592.
2141:10.1056/nejmoa1010502
1044:Nissen fundoplication
893:
694:
675:and narrowing at the
654:
633:endoscopic ultrasound
598:
489:
352:esophageal dilatation
3108:Esophageal achalasia
3077:Esophageal achalasia
2905:(20 November 1999).
2719:. pp. 109β121.
1283:10.1136/gut.49.1.145
1098:Planetary scientist
1071:Heller's in England.
1048:Swiss Medical Weekly
1040:Ferdinand Sauerbruch
856:Pneumatic dilatation
850:Pneumatic dilatation
832:isosorbide dinitrate
731:nutcracker achalasia
687:Esophageal manometry
621:esophageal manometry
470:Late-stage achalasia
418:of undigested food,
337:esophageal manometry
251:Esophageal achalasia
236:~1 in 100,000 people
135:laparoscopic surgery
36:Esophageal achalasia
3133:Esophagus disorders
808:Barrett's esophagus
717:muscle contractions
273:; achalasia of the
3038:External resources
2686:10.1007/BF02231426
2184:. 10 October 2017.
1017:inability to relax
924:Endoscopic myotomy
896:
782:pneumatic dilation
701:
661:
601:
492:
406:Signs and symptoms
257:, is a failure of
3086:
3085:
2863:(35): 5806β5812.
2750:Annals of Surgery
2734:978-3-319-25092-2
2395:Annals of Surgery
2374:. 14 October 2020
2316:Annals of Surgery
2134:(19): 1807β1816.
2087:(11): 2303β2311.
2018:978-0-7817-4733-2
1968:(14): 1573β1578.
1853:Annals of Surgery
1363:(18): 1841β1852.
1152:10.1111/jgh.15557
1146:(10): 2828β2833.
984:Sir Thomas Willis
792:Lifestyle changes
577:neurodegenerative
538:neurotransmission
395:"no relaxation."
383:Triple-A syndrome
375:esophageal cancer
248:
247:
198:Diagnostic method
30:Medical condition
16:(Redirected from
3140:
2954:
2942:
2941:
2930:
2924:
2923:
2921:
2919:
2899:
2893:
2892:
2882:
2872:
2848:
2842:
2841:
2832:(9): 1749β1752.
2817:
2811:
2810:
2808:
2807:
2798:. Archived from
2788:
2782:
2781:
2745:
2739:
2738:
2712:
2706:
2705:
2669:
2663:
2662:
2634:
2628:
2627:
2625:
2610:Gastroenterology
2601:
2595:
2594:
2576:
2552:
2546:
2545:
2535:
2511:
2505:
2504:
2476:
2470:
2469:
2433:
2427:
2426:
2401:(6): 1023β1030.
2389:
2383:
2382:
2380:
2379:
2364:
2358:
2357:
2347:
2307:
2301:
2300:
2290:
2281:(4): 1191β1195.
2266:
2260:
2259:
2249:
2232:(12): CD005046.
2217:
2211:
2210:
2208:
2207:
2202:. 29 August 2018
2192:
2186:
2185:
2178:
2172:
2171:
2153:
2143:
2119:
2113:
2112:
2076:
2067:
2066:
2029:
2023:
2022:
2004:
1998:
1997:
1987:
1977:
1953:
1947:
1936:
1930:
1929:
1893:
1887:
1886:
1876:
1844:
1838:
1837:
1827:
1803:
1797:
1796:
1786:
1762:
1756:
1755:
1745:
1721:
1715:
1714:
1689:(9): 1134β1137.
1678:
1672:
1671:
1661:
1652:(6): 1077β1084.
1637:
1631:
1630:
1620:
1596:
1590:
1589:
1569:
1563:
1562:
1526:
1520:
1519:
1509:
1494:Gastroenterology
1485:
1479:
1478:
1460:
1436:
1427:
1426:
1398:
1381:
1380:
1352:
1346:
1345:
1335:
1320:Gastroenterology
1311:
1305:
1304:
1294:
1262:
1256:
1255:
1230:(6): 1404β1414.
1219:
1213:
1212:
1205:
1199:
1198:
1178:
1172:
1171:
1134:
1125:
1120:
1094:Notable patients
945:Heller myotomy.
884:keyhole approach
872:Heller's Myotomy
760:myenteric plexus
671:tapering at the
502:Dumping syndrome
452:small intestines
331:, and sometimes
127:thoracic surgery
123:Gastroenterology
108:
107:
104:
103:
100:
97:
94:
91:
88:
85:
82:
79:
76:
53:
33:
21:
3148:
3147:
3143:
3142:
3141:
3139:
3138:
3137:
3123:
3122:
3106:
3087:
3082:
3081:
3033:
3032:
2965:
2951:
2946:
2945:
2940:. 14 June 2021.
2932:
2931:
2927:
2917:
2915:
2901:
2900:
2896:
2850:
2849:
2845:
2828:(in Japanese).
2819:
2818:
2814:
2805:
2803:
2790:
2789:
2785:
2747:
2746:
2742:
2735:
2714:
2713:
2709:
2680:(10): 954β961.
2671:
2670:
2666:
2636:
2635:
2631:
2603:
2602:
2598:
2554:
2553:
2549:
2513:
2512:
2508:
2478:
2477:
2473:
2435:
2434:
2430:
2391:
2390:
2386:
2377:
2375:
2366:
2365:
2361:
2309:
2308:
2304:
2268:
2267:
2263:
2219:
2218:
2214:
2205:
2203:
2194:
2193:
2189:
2180:
2179:
2175:
2121:
2120:
2116:
2078:
2077:
2070:
2035:Human Pathology
2031:
2030:
2026:
2019:
2006:
2005:
2001:
1955:
1954:
1950:
1937:
1933:
1895:
1894:
1890:
1846:
1845:
1841:
1805:
1804:
1800:
1764:
1763:
1759:
1723:
1722:
1718:
1680:
1679:
1675:
1639:
1638:
1634:
1598:
1597:
1593:
1571:
1570:
1566:
1528:
1527:
1523:
1487:
1486:
1482:
1438:
1437:
1430:
1400:
1399:
1384:
1354:
1353:
1349:
1313:
1312:
1308:
1264:
1263:
1259:
1221:
1220:
1216:
1207:
1206:
1202:
1180:
1179:
1175:
1136:
1135:
1128:
1121:
1117:
1112:
1096:
1088:
1038:, a student of
979:
954:
926:
880:
858:
846:Botulinum toxin
816:
794:
768:
746:
689:
649:
623:. In addition,
593:
587:contributions.
510:
472:
408:
131:general surgery
112:
73:
69:
31:
28:
23:
22:
15:
12:
11:
5:
3146:
3144:
3136:
3135:
3125:
3124:
3121:
3120:
3114:
3090:
3084:
3083:
3080:
3079:
3068:
3054:
3042:
3041:
3039:
3035:
3034:
3031:
3030:
3019:
3008:
2997:
2982:
2966:
2961:
2960:
2958:
2957:Classification
2950:
2949:External links
2947:
2944:
2943:
2925:
2903:Porco, Carolyn
2894:
2843:
2812:
2783:
2756:(5): 875β878.
2740:
2733:
2707:
2664:
2629:
2596:
2567:(4): 401β406.
2547:
2526:(2): 330β338.
2506:
2487:(2): 256β264.
2471:
2444:(4): 265β271.
2428:
2384:
2359:
2322:(5): 631β639.
2302:
2261:
2212:
2187:
2173:
2114:
2068:
2024:
2017:
1999:
1948:
1931:
1904:(3): 219β225.
1888:
1859:(3): 324β336.
1839:
1818:(3): 340β345.
1798:
1777:(3): 854β858.
1757:
1736:(4): 305β309.
1716:
1673:
1632:
1611:(3): 204β208.
1591:
1580:(3): 277β285.
1564:
1537:(4): 353β364.
1531:Human Genetics
1521:
1500:(2): 369β374.
1480:
1451:(6): 909β918.
1428:
1409:(7): 638β642.
1382:
1347:
1326:(1): 209β224.
1306:
1277:(1): 145β151.
1257:
1214:
1200:
1173:
1126:
1114:
1113:
1111:
1108:
1095:
1092:
1087:
1084:
1083:
1082:
1075:
1072:
1065:
1058:
1051:
1036:Rudolph Nissen
1032:
1020:
1013:
1010:Heller myotomy
1006:
999:
994:attached to a
978:
975:
973:if untreated.
953:
950:
925:
922:
900:fundoplication
879:
876:
857:
854:
815:
812:
793:
790:
786:Heller myotomy
767:
764:
745:
742:
741:
740:
737:
734:
727:
688:
685:
648:
647:Barium swallow
645:
617:barium swallow
592:
589:
534:ganglion cells
509:
506:
471:
468:
407:
404:
379:Chagas disease
356:Heller myotomy
341:barium swallow
296:involving the
246:
245:
242:
238:
237:
234:
230:
229:
226:
220:
219:
216:
212:
211:
208:
204:
203:
200:
194:
193:
190:
184:
183:
180:
176:
175:
168:
164:
163:
160:
156:
155:
152:
148:
147:
144:
138:
137:
120:
114:
113:
111:
110:
66:
64:
60:
59:
55:
54:
46:
45:
42:
38:
37:
29:
26:
24:
14:
13:
10:
9:
6:
4:
3:
2:
3145:
3134:
3131:
3130:
3128:
3118:
3115:
3113:
3109:
3104:
3100:
3099:
3094:
3089:
3088:
3078:
3074:
3073:
3069:
3067:
3064:
3060:
3059:
3055:
3053:
3049:
3048:
3044:
3043:
3040:
3036:
3029:
3025:
3024:
3020:
3018:
3014:
3013:
3009:
3007:
3003:
3002:
2998:
2996:
2992:
2991:
2987:
2983:
2981:
2977:
2976:
2972:
2968:
2967:
2964:
2959:
2955:
2948:
2939:
2935:
2929:
2926:
2914:
2913:
2908:
2904:
2898:
2895:
2890:
2886:
2881:
2876:
2871:
2866:
2862:
2858:
2854:
2847:
2844:
2839:
2835:
2831:
2827:
2823:
2816:
2813:
2802:on 2021-12-05
2801:
2797:
2793:
2787:
2784:
2779:
2775:
2771:
2767:
2763:
2759:
2755:
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2744:
2741:
2736:
2730:
2726:
2722:
2718:
2711:
2708:
2703:
2699:
2695:
2691:
2687:
2683:
2679:
2675:
2668:
2665:
2660:
2656:
2652:
2648:
2644:
2641:(in German).
2640:
2633:
2630:
2624:
2619:
2615:
2611:
2607:
2600:
2597:
2592:
2588:
2584:
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2575:
2570:
2566:
2562:
2558:
2551:
2548:
2543:
2539:
2534:
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2521:
2517:
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2507:
2502:
2498:
2494:
2490:
2486:
2482:
2475:
2472:
2467:
2463:
2459:
2455:
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2439:
2432:
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2213:
2201:
2197:
2191:
2188:
2183:
2177:
2174:
2169:
2165:
2161:
2157:
2152:
2151:11577/2478108
2147:
2142:
2137:
2133:
2129:
2125:
2118:
2115:
2110:
2106:
2102:
2098:
2094:
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2069:
2064:
2060:
2056:
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2048:
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2040:
2036:
2028:
2025:
2020:
2014:
2010:
2003:
2000:
1995:
1991:
1986:
1981:
1976:
1971:
1967:
1963:
1959:
1952:
1949:
1946:
1942:
1941:
1935:
1932:
1927:
1923:
1919:
1915:
1911:
1907:
1903:
1899:
1892:
1889:
1884:
1880:
1875:
1870:
1866:
1862:
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1813:
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1086:Epidemiology
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967:premalignant
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3047:MedlinePlus
2659:10008497300
2368:"Achalasia"
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1209:"Achalasia"
1104:Edgar Lungu
1069:laproscopic
1029:cardiospasm
756:musculature
665:fluoroscopy
611:, and even
561:eosinophils
518:substance P
497:anastomotic
462:, eventual
456:weight loss
428:weight loss
422:behind the
310:peristalsis
151:Usual onset
41:Other names
3072:Patient UK
3023:DiseasesDB
2806:2021-12-05
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2378:2021-06-25
2206:2021-06-25
1110:References
1100:Carl Sagan
996:whale bone
992:sea sponge
952:Monitoring
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824:nifedipine
814:Medication
774:nifedipine
771:Sublingual
573:hereditary
569:autoimmune
565:mast cells
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464:starvation
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333:chest pain
207:Prevention
3058:eMedicine
2438:Endoscopy
2336:0003-4932
1945:eMedicine
1940:Achalasia
1168:235200001
1062:posterior
1025:achalasia
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905:soft diet
766:Treatment
705:manometry
637:endoscopy
625:endoscopy
591:Diagnosis
585:infective
508:Mechanism
412:dysphagia
393:-chalasia
302:esophagus
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255:achalasia
233:Frequency
224:Prognosis
215:Treatment
118:Specialty
18:Achalasia
3127:Category
3093:template
2889:24124325
2838:20845759
2778:22728462
2770:21451393
2702:29470586
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2651:13337262
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2256:25485740
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1467:16948803
1377:25965233
1342:15633138
1301:11413123
1252:33583131
1244:15929777
1160:34032322
1055:anterior
909:anterior
840:headache
830:such as
828:nitrates
822:such as
713:catheter
607:(GERD),
460:anorexia
432:coughing
318:fibrosis
304:and the
162:Lifelong
159:Duration
142:Symptoms
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3063:radio/6
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1195:3259530
917:robotic
878:Surgery
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681:dilated
581:genetic
424:sternum
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1164:S2CID
1027:over
1023:term
669:acute
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2990:9-CM
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