ACHALASIA: DIAGNOSTIC FEATURES AND EFFECTIVE TREATMENT METHODS. REVIEW

Еsophageal achalasia is a neuromuscular disease of esophagus characterized by a distortion of the relaxation of the lower esophageal sphincter (LES) and manifested by marked clinical symptoms. To date, methods for diagnosing pathology and various surgical methods for its correction have been developed and actively used. In this review, the authors summarized all available data on principles of modern classification based on the identification of characteristic diagnostic criteria of the disease. The modern treatment methods are described in detail, the effectiveness of the presented methods is evaluated.

esophageal achalasia, classification of achalasia, balloon (pneumatic) dilation, peroral endoscopic myotomy (POEM), Heller's myotomy

1. Khashab MA, Vela MF, Thosani N, Agrawal D, Buxbaum JL, Abbas Fehmi SM, Fishman DS, Gurudu SR, Jamil LH, Jue TL, Kannadath BS, Law JK, Lee JK, Naveed M, Qumseya BJ, Sawhney MS, Yang J, Wani S. ASGE guideline on the management of achalasia. Gastrointest Endosc. 2020;91(2):213-227.e6. https://doi.org/10.1016/ j.gie.2006.02.002

2. Schlottmann F, Neto RML, Herbella FAM, Patti MG. Esophageal Achalasia: Pathophysiology, Clinical Presentation, and Diagnostic Evaluation. Am Surg. 2018;1; 84(4):467-472

3. Boeckxstaens GE, Zaninotto G, Richter JE. Achalasia. Lancet. 2014;4;383(9911):83-93. https://doi.org/10.1016/s0140-6736(13)60651-0

4. Ghoshal UC, Daschakraborty SB, Singh R. Pathogenesis of achalasia cardia. World J Gastroenterol. 2012;18(24):3050. https:// doi.org/10.3748/wjg.v18.i24.3050

5. Patel DA, Kim HP, Zifodya JS, Vaezi MF. Idiopathic (primary) achalasia: a review. Orphanet J Rare Dis. 2015;22;10(1):89. https://doi.org/10.1186/s13023-015-0302-1

6. Ivashkin V. T., Trukhmanov A. S., Godzhello E. A., Mayev I. V., Evsyutina Yu. V., Lapina T. L., Storonova O. A. Diagnostics and treatment of cardiac achalasia and cardiospasm: guidelines of the Russian gastroenterological association. Ross z gastroenterol gepatol koloproktol. 2016;26(4):36-54. (In Russ.) https://doi.org/10.22416/ 1382-4376-2016-26-4-36-54

7. Gasanov AM, Aliev NA, Danielyan ShN. Esophageal achalasia. Khirurgiya. Zurnal imeni N.I. Pirogova. 2019; 2:72-77. (In Russ.) https://doi. org/10.17116/ hirurgia201902172 https://doi.org/10.17116/ hirurgia201902172

8. Furuzawa-Carballeda J, Torres-Landa S, Valdovinos MÁ, Coss-Adame E, Martín Del Campo LA, Torres-Villalobos G. New insights into the pathophysiology of achalasia and implications for future treatment. World J Gastroenterol. 2016;22(35):7892-7907. https://doi.org/10.3748/wjg.v22.i35.7892

9. Zaninotto G, Bennett C, Boeckxstaens G, Costantini M, Ferguson MK, Pandolfino JE, Patti MG, Ribeiro U Jr, Richter J, Swanstrom L0, Tack J, Triadafilopoulos G, Markar SR, Salvador R, Faccio L, Andreollo NA, Cecconello I, Costamagna G, da Rocha JRM, Hungness ES, Fisichella PM, Fuchs KH, Gockel I, Gurski R, Gyawali CP, Herbella FAM, Holloway RH, Hongo M, Jobe BA, Kahrilas PJ, Katzka DA, Dua KS, Liu D, Moonen A, Nasi A, Pasricha PJ, Penagini R, Perretta S, Sallum RAA, Sarnelli G, Savarino E, Schlottmann F, Sifrim D, Soper N, Tatum RP, Vaezi MF, van Herwaarden-Lindeboom M, Vanuytsel T, Vela MF, Watson DI, Zerbib F, Gittens S, Pontillo C, Vermigli S, Inama D, Low DE. The 2018 ISDE achalasia guidelines. Dis Esophagus. 2018;1;31(9). https://doi.org/10.1093/dote/doy071

10. Rohof WOA, Bredenoord AJ. Chicago classification of esophageal motility disorders: lessons learned. Curr Gastroenterol Rep. 2017;19(8):37. https://doi.org/10.1007/s11894-017-0576-7

11. Vaezi MF, Pandolfino JE, Vela MF. ACG clinical guideline: diagnosis and management of achalasia. Am J Gastroenterol. 2013;108(8):1238-1249. https://doi.org/10.1038/ajg.2013.196

12. Japan Esophageal Society. Descriptive Rules for Achalasia of the Esophagus, June 2012: 4th Edition. Esophagus. 2017;14(4):275-289. https://doi.org/10.1007/s10388-017-0589-1

13. Pandolfino JE, Gawron AJ. Achalasia: a systematic review. JAMA. 2015;313(18):1841-1852. https://doi.org/10.1001/jama.2015.2996

14. Zanoni A, Rice TW, Lopez R, Birgisson S, Shay SS, Thota PN, Baker ME, Raymond DP, Blackstone EH. Timed barium esophagram in achalasia types. Dis Esophagus. 2015;28(4):336-344. https://doi.org/10.1111/dote.12212

15. Fisichella PM. The New Era of Journal of Laparoendoscopic & Advanced Surgical Techniques. J Laparoendosc Adv Surg Tech A. 2016;26(4):239. https://doi.org/10.1089/lap.2016.29006.pmf

16. Krill JT, Naik RD, Vaezi MF. Clinical management of achalasia: current state of the art. Clin Exp Gastroenterol. 2016;9:71-82. https://doi.org/10.2147/ceg.s84019

17. Ihara E, Muta K, Fukaura K, Nakamura K. Diagnosis and Treatment Strategy of Achalasia Subtypes and Esophagogastric Junction Outflow Obstruction Based on High-Resolution Manometry. Digestion. 2017;95(1):29-35. https://doi.org/10.1159/000452354

18. Tuason J, Inoue H.Current status of achalasia management: a review on diagnosis and treatment. J Gastroenterol. 2017;52(4):401-406. https://doi.org/10.1007/s00535-017-1314-5

19. Stavropoulos SN, Friedel D, Modayil R, Parkman HP. Diagnosis and management of esophageal achalasia. BMJ; 2016;354:i2785. https://doi.org/10.1136/bmj.i2785

20. Felix VN. Results of pneumatic dilation in treating achalasia: predictive factors. Ann N Y Acad Sci. 2018;1434(1):124-131. https://doi.org/10.1111/nyas.13844

21. Bonifácio P, de Moura DTH, Bernardo WM, de Moura ETH, Farias GFA, Neto ACM, Lordello M, Korkischko N, Sallum R, de Moura EGH. Pneumatic dilation versus laparoscopic Heller's myotomy in the treatment of achalasia: systematic review and meta-analysis based on randomized controlled trials. Dis Esophagus. 2019;32(2). https://doi.org/10.1093/dote/doy105

22. Miranda García P, Casals Seoane F, Gonzalez JM, Barthet M, Santander Vaquero C. Per-oral endoscopic myotomy (POEM): a new endoscopic treatment for achalasia. Rev Esp Enferm Dig. 2017;109(10):719-726. https://doi.org/10.17235/reed.2017.4732/2016

23. Raja S, Murthy SC, Tang A, Siddiqui HU, Parikh MP, Ahmad U, Gabbard S, Thota P, Ray MN, Wadhwa N, Sanaka MR. Per oral endoscopic myotomy: Another tool in the toolbox. J Thorac Cardiovasc Surg. 2019;158(3):945-951. https://doi.org/10.1016/ j.jtcvs.2018.11.132

24. Werner YB, Hakanson B, Martinek J, Repici A, von Rahden BHA, Bredenoord AJ, Bisschops R, Messmann H, Vollberg MC, Noder T, Kersten JF, Mann O, Izbicki J, Pazdro A, Fumagalli U, Rosati R, Germer CT, Schijven MP, Emmermann A, von Renteln D, Fockens P, Boeckxstaens G, Rösch Т. Endoscopic or Surgical Myotomy in Patients with Idiopathic Achalasia. N Engl J Med. 2019;381(23):2219-2229. https://doi.org/10.1056/NEJMoa1905380

25. Galliamov E. A., Agapov M. A., Lucevich O. E., Kubishkin V. A., Erin S. A., Presnov K. S., Busyrev Yu. B., Kakotkin V. V., Torosyan O. G. Laparoscopic correction of recurrence of gastroesophageal reflux disease and hernia of the esophageal aperture of the diaphragm. Surgical practice. 2019;(3):33-40. (In Russ.) https://doi.org/10.38181/issn2223-2427.2019.3.33-40

26. Kurian AA, Bhayani N, Sharata A, Reavis K, Dunst CM, Swanström LL. Partial anterior vs partial posterior fundoplication following transabdominal esophagocardiomyotomy for achalasia of the esophagus: meta-regression of objective postoperative gastroesophageal reflux and dysphagia. JAMA Surg. 2013;148(1):85-90. https://doi.org/ 10.1001/jamasurgery.2013.409

27. Rawlings A, Soper NJ, Oelschlager B, Swanstrom L, Matthews BD, Pellegrini C, Pierce RA, Pryor A, Martin V, Frisella MM, Cassera M, Brunt LM. Laparoscopic Dor versus Toupet fundoplication following Heller myotomy for achalasia: results of a multicenter, prospective, randomized-controlled trial. Surg Endosc. 2012;26(1):18-26. https://doi.org/10.1007/s00464-011-1822-y

28. Mayo D, Griffiths EA, Khan OA, Szymankiewicz MA, Wakefield CW, Thompson SK. Does the addition of a fundoplication improve outcomes for patients undergoing laparoscopic Heller's cardiomyotomy? Int J Surg. 2012;10(6):301-304. https://doi.org/ 10.1016/j.ijsu.2012.04.002

29. Katzka DA, Castell DO. Review article: an analysis of the efficacy, perforation rates and methods used in pneumatic dilation for achalasia. Aliment Pharmacol Ther. 2011;34(8):832-839. https://doi.org/10.1111/j.1365-2036.2011.04816.x.

30. An Moonen, Annese V, Ann Belmans A, Bredenoord AJ, des Varannes SB, Costantini M, Dousset B, Elizalde JI, Fumagalli U, Gaudric M, Merla A, Smout AJ, Tack J, Zaninotto G, Busch OR, Boeckxstaens GE. Long-term results of the European achalasia trial: a multicentre randomised controlled trial comparing pneumatic dilation versus laparoscopic Heller myotomy. Gut 2016;65(5):732-739. https://doi.org/10.1136/gutjnl-2015-310602.

31. Li YD, Tang GY, Cheng YS, Chen NW, Chen WX, Zhao JG. 13-Year Follow-Up of a Prospective Comparison of the Long-Term Clinical Efficacy of Temporary Self-Expanding Metallic Stents and Pneumatic Dilatation for the Treatment of Achalasia in 120 Patients. AJR Am J Roentgenol 2010;195(6):1429-1437. https://doi.org/ 10.2214/ajr.10.4407

32. Allaix ME, Patti MG. What is the Best Primary Therapy for Achalasia: Medical or Surgical Treatment? Who Owns Achalasia? J Gastrointest Surg. 2013;17(9):1547-1549. https://doi.org/10.1007/ s11605-013-22