ASGE Esophagology General GI Practice Virtual Program (LIVE Virtual) | April 2021-Tailoring Treatment in Achlasia

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This document provides information on the tailoring of treatment in achalasia, a disorder characterized by the inability of the esophagus to properly move food into the stomach. The document discusses different types of achalasia and various treatment options.<br /><br />There are three subtypes of achalasia: classic achalasia (Type I), spastic achalasia (Type III), and achalasia with compression (Type II). Each subtype has different characteristics and requires tailored treatment approaches.<br /><br />The document outlines several treatment options for achalasia, including Botox injections, pneumatic dilation, laparoscopic Heller myotomy (LHM), and per-oral esophageal myotomy (POEM). Botox injections are temporary and less effective than other treatments, but they are an easy and safe option. Pneumatic dilation is less invasive than LHM or POEM and effectively stops the progression of esophageal dilation. LHM involves a surgical myotomy and is certain to halt the progression of esophageal dilation. POEM is an alternative to LHM or pneumatic dilation, and it has shown high success rates across all types of achalasia.<br /><br />The success rates of the various treatments differ based on the subtype of achalasia. LHM and POEM have higher success rates in Type I and Type III achalasia, while pneumatic dilation is more acceptable for Type II. POEM has been shown to be more successful than LHM for Types I and III achalasia.<br /><br />It is important to note that there is a risk of post-treatment gastroesophageal reflux disease (GERD) following some treatments, particularly POEM, which may lead to esophagitis. However, the overall efficacy of POEM in halting the progression of esophageal dilation is high.<br /><br />In summary, the document highlights the importance of tailoring treatment approaches based on the subtype of achalasia. While there are different treatment options available, POEM is emerging as a preferred option due to its high success rates and minimal surgical morbidity.

Asset Subtitle

Peter J. Kahrilas, MD

Keywords

achalasia

tailoring treatment

subtypes

treatment options

Botox injections

pneumatic dilation

laparoscopic Heller myotomy

POEM

success rates

GERD