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      Current therapies for achalasia: comparison and efficacy.

      1 ,
      Journal of clinical gastroenterology
      Ovid Technologies (Wolters Kluwer Health)

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          Abstract

          Achalasia is a primary esophageal motor disorder of unknown etiology producing complaints of dysphagia, regurgitation, and chest pain. The current treatments for achalasia involve the reduction of lower esophageal sphincter (LES) pressure resulting in improved esophageal emptying. Calcium channel blockers and nitrates, once used as initial treatment strategy for early achalasia, are now only used in patients who are not candidates for pneumatic dilation or surgery and those not responding to botulinum toxin injections. By virtue of the more rigid balloons, the current pneumatic dilators are more effective and have better efficacy than the older more compliant balloons. The graded approach to pneumatic dilation using the Rigiflex balloons (3.0, 3.5, and 4.0 cm) are now the most commonly used nonsurgical means of treating patients with achalasia, resulting in symptom improvement in up to 90% of patients. Surgical myotomy, once with high morbidity and long hospital stay, can now be performed laparoscopically with similar efficacy to the open surgical approach (94% vs. 84%, respectively), reduced morbidity, and hospitalization time. Given the advances in both balloon dilation and laparoscopic myotomy, most patients with achalasia can now choose between these two equally efficacious treatment options. Botulinum toxin injection of the LES should be reserved for patients who cannot undergo balloon dilation and are not surgical candidates.

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          Author and article information

          Journal
          J Clin Gastroenterol
          Journal of clinical gastroenterology
          Ovid Technologies (Wolters Kluwer Health)
          0192-0790
          0192-0790
          Jul 1998
          : 27
          : 1
          Affiliations
          [1 ] Department of Gastroenterology, The Cleveland Clinic Foundation, Ohio 44195, USA.
          Article
          10.1097/00004836-199807000-00006
          9706766
          d9583672-588a-413a-9891-4379632167fa
          History

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