Page 34 - WJOLS - Journal of Laparoscopic Surgery

WJOLS

Achalasia Cardia: Revisited
should be checked every year or two with a timed barium 9. de Oliveira JM, Birgisson S, Doinoff C, Einstein D, Herts B,
swallow because some may need pneumatic dilatations, Davros W, Obuchowski N, Koehler RE, Richter J, Baker ME.
a repeat myotomy, or even esophagectomy after many Timed barium swallow: a simple technique for evaluating
years. In addition, some physicians recommend pH esophageal emptying in patients with achalasia. AJR Am
J Roentgenol 1997 Aug;169(2):473-479.
testing and endoscopy to check for reflux damage, which 10. Farrokhi F, Vaezi MF. Idiopathic (primary) achalasia.
may lead to Barret’s esophagus or a stricture if untreated. 1 Orphanet J Rare Dis 2007 Sep;2:38.
11. Kessing BF, Smout AJ, Bredenoord AJ. Clinical applications
LIFESTYLE CHANGES of esophageal impedance monitoring and high-resolution
manometry. Curr Gastroenterol Rep 2012 Jun;14(3):197-205.
The treatment of achalasia cardia demands a host of 12. Gold, BD. Achalasia. Clinical Advisor. Available from:
lifestyle changes that improve the outcome as well as http://www.clinicaladvisor.com/pediatrics/achalasia/
quality of life if followed as routine habit. Achalasia article/624740/.
patients may require to eat meals slowly, chew the food 13. Gelfond M, Rozen P, Gilat T. Isosorbide dinitrate and nife-
dipine treatment of achalasia: a clinical, manometric and
very well, drink adequate water with meals, and avoid radionuclide evaluation. Gastroenterology 1982 Nov;83(5):
eating dinner immediately before going to bed. Emptying 963-969.
of the esophagus by gravity is promoted by raising the 14. Bortolotti M, Coccia G, Brunelli F, Sarti P, Mazza M, Bagnato F,
head end of the bed or sleeping with a wedge pillow. After Barbara L. Isosorbide dinitrate or nifedipine: which is prefer-
surgery or pneumatic dilatation, proton pump inhibitors able in the medical therapy of achalasia? Ital J Gastroenterol
1994 Oct-Nov;26(8):379-382.
can help prevent reflux damage by inhibiting gastric acid 15. Smith CD, Stival A, Howell DL, Swafford V. Endoscopic
secretion; and foods that can aggravate reflux, including therapy for achalasia before Heller myotomy results in
ketchup, citrus, chocolate, mint, alcohol, and caffeine, are worse outcomes than Heller myotomy alone. Ann Surg 2006
better avoided. 33 May;243(5):579-584, discussion 584-586.
16. Dughera L, Battaglia E, Maggio D, Cassolino P, Mioli PR,
Morelli A, Emanuelli G, Bassotti G. Botulinum toxin treat-
CONCLUSION ment of oesophageal achalasia in the old old and oldest old: a
The understanding of the pathophysiology of achalasia 1-year follow-up study. Drugs Aging 2005 Sep;22(9):779-783.
cardia is important to initiate treatment, and the failure 17. Gideon RM, Castell DO, Yarze J. Prospective randomized
comparison of pneumatic dilatation technique in patients with
of the medical treatment calls for a definitive surgical idiopathic achalasia. Dig Dis Sci 1999 Sep;44(9):1853-1857.
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depends on patient compliance and lifestyle changes with scope-guided pneumatic dilation for treatment of esophageal
appropriate follow-up. achalasia. World J Gastroenterol 2010 Jan;16(4):411-417.
19. Eckardt VF, Kanzler G, Westermeier T. Complications and
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