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Blonski W, Slone S, Richter JE. Update on the Diagnosis and Treatment of Achalasia. Dysphagia 2023; 38:596-608. [PMID: 35585208 DOI: 10.1007/s00455-022-10435-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 03/04/2022] [Indexed: 12/23/2022]
Abstract
Achalasia is a rare disease of the esophagus with impaired relaxation of the lower esophageal sphincter and aperistalsis. The etiology is unknown but speculations include a viral or autoimmune etiology. All specialists dealing with swallowing and esophageal diseases should recognize the classic symptoms of dysphagia for solids/liquids, regurgitation, and choking, especially at night. High-resolution manometry is critical for the diagnosis with endoscopy and barium esophagram having a supportive role. The disease cannot be cured but most can return to near normal swallowing and a regular diet with appropriate therapy. Treatment includes smooth muscle relaxants, botulinum toxin injections to the lower sphincter, pneumatic dilation, Heller myotomy, and peroral endoscopic myotomy. One treatment does not fit all and a tailored approach through a multidiscipline team will give the best long-term outcomes.
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Affiliation(s)
- Wojciech Blonski
- Division of Gastroenterology, James A. Haley VA Hospital, Tampa, FL, USA
- Division of Gastroenterology and Nutrition, Morsani College of Medicine, University of South Florida, 12901 Bruce B. Downs Blvd, MDC 72, Tampa, FL, 33612, USA
| | - Samuel Slone
- Division of Gastroenterology and Nutrition, Morsani College of Medicine, University of South Florida, 12901 Bruce B. Downs Blvd, MDC 72, Tampa, FL, 33612, USA
| | - Joel E Richter
- Division of Gastroenterology and Nutrition, Morsani College of Medicine, University of South Florida, 12901 Bruce B. Downs Blvd, MDC 72, Tampa, FL, 33612, USA.
- Joy McCann Culverhouse Center for Esophageal Diseases, Morsani College of Medicine, University of South Florida, Tampa, FL, USA.
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Blonski W, Kumar A, Jacobs J, Feldman J, Richter JE. Impact of opioids on treatment response among idiopathic esophagogastric junction outflow obstruction patients: A retrospective cohort study. Indian J Gastroenterol 2023; 42:136-142. [PMID: 36781814 DOI: 10.1007/s12664-022-01311-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 11/07/2022] [Indexed: 02/15/2023]
Abstract
BACKGROUND Esophageal dysmotility has been attributed to opioid use. The goal was to assess the differences in pre- and post-treatment timed-barium esophagram (TBE) barium heights at 1 and 5 minutes and symptomatic response to treatment in esophagogastric junction outflow obstruction (EGJOO) patients according to opioid use status. METHODS We performed a retrospective cohort study. Consecutive patients with EGJOO were eligible for inclusion. Data were collected on demographics, pre and post-treatment 1 and 5 minutes TBE barium heights and symptom outcomes. Groups were compared according to opioid use. RESULTS Thirty-one EGJOO patients met the inclusion criteria. All patients were treated with pneumatic dilation. Of the 31 patients, 11 (35%) had opioid exposure and 20 (65%) did not. The median follow-up post-treatment was two months (range 1-47 months). There was no statistically significant difference in post-treatment outcomes for opioid exposed vs. unexposed groups. The median per cent decrease in the TBE barium height at 1 minute was 100% for the opioid exposed vs. 71% for the unexposed group (p = 0.92). The median per cent decrease in the TBE barium height at 5 minutes was zero % for the opioid exposed and unexposed groups (p = 0.67). The incidence of symptomatic improvement was 82% (9/11) for the opioid exposed group vs 95% (19/20) for the unexposed group (p = 0.28). CONCLUSIONS Patients with EGJOO seem to respond to treatment similarly regardless of being on opioids.
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Affiliation(s)
- Wojciech Blonski
- Joy McCann Culverhouse Center for Swallowing Disorders, Division of Digestive Diseases and Nutrition, University of South Florida Health Morsani College of Medicine, 12901 Bruce B. Downs Blvd. MDC 72, Tampa, FL, 33612, USA
- Department of Gastroenterology, James A. Haley Veterans' Hospital, Tampa, FL, USA
| | - Ambuj Kumar
- Research Methodology and Biostatistics Core, Office of Research, Department of Internal Medicine, University of South Florida Health Morsani College of Medicine, Tampa, FL, USA
| | - John Jacobs
- Joy McCann Culverhouse Center for Swallowing Disorders, Division of Digestive Diseases and Nutrition, University of South Florida Health Morsani College of Medicine, 12901 Bruce B. Downs Blvd. MDC 72, Tampa, FL, 33612, USA
| | - John Feldman
- Department of Radiology, University of South Florida Health Morsani College of Medicine, Tampa, FL, USA
| | - Joel E Richter
- Joy McCann Culverhouse Center for Swallowing Disorders, Division of Digestive Diseases and Nutrition, University of South Florida Health Morsani College of Medicine, 12901 Bruce B. Downs Blvd. MDC 72, Tampa, FL, 33612, USA.
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Clayton SB, Shin CM, Ewing A, Blonski W, Richter J. Pneumatic dilation improves esophageal emptying and symptoms in patients with idiopathic esophago-gastric junction outflow obstruction. Neurogastroenterol Motil 2019; 31:e13522. [PMID: 30536798 DOI: 10.1111/nmo.13522] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 11/05/2018] [Accepted: 11/08/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND AIMS Idiopathic Esophago-gastric outflow obstruction (EGJOO) is a new clinical entity resulting in delayed esophageal emptying secondary to a poorly relaxing lower esophageal sphincter. Little is known about treatment outcomes of idiopathic EGJOO patients. The aim of this study was to investigate the clinical response of pneumatic dilation (PD) in idiopathic EGJOO patients with a standing barium column and/or with pill arrest on timed barium esophagram (TBE) before and after undergoing PD. METHODS Idiopathic EGJOO patients with retained liquid barium on TBE at 1 minute and/or with pill arrest in esophagus at 5 minutes were included. Patients were treated with PD and evaluated with post-procedural TBE. RESULTS A total of 33 patients with Idiopathic EGJOO and poor esophageal emptying on TBE were treated with PD. 67% of Idiopathic EGJOO patients reported subjective symptom relief, 18% improved and symptoms later recurred, 6% were lost to follow up, and 9% reported no change. TBE results of pre-PD showed 1 minute average barium column height of 11.0 cm and 1 minute barium column width of 1.7 cm. There was significant decrease in 1 minute liquid barium column height and width (P < 0.001 and <0.001, respectively) as well as significant improvement in pill passing (P < 0.006) after undergoing PD. No complications occurred after PD. CONCLUSION PD is an effective initial treatment for Idiopathic EGJOO patients with abnormal TBE. Pneumatic dilation relieved symptoms and improved esophageal emptying in Idiopathic EGJOO patients on TBE.
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Affiliation(s)
- Steven B Clayton
- Department of Internal Medicine, Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina
| | - Claire M Shin
- Department of Medicine, University of South Carolina School of Medicine Greenville, Greenville, South Carolina
| | - Alex Ewing
- Department of Medicine, University of South Carolina School of Medicine Greenville, Greenville, South Carolina.,Greenville Health System, Greenville, South Carolina
| | - Wojciech Blonski
- Department of Internal Medicine, Division of Digestive Diseases, University of South Florida, Tampa, Florida
| | - Joel Richter
- Department of Internal Medicine, Division of Digestive Diseases and Nutrition, Joy McCann Culverhouse Center for Swallowing Disorders, University of South Florida, Tampa, Florida
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Baniya R, Upadhaya S, Khan J, Subedi SK, Shaik Mohammed T, Ganatra BK, Bachuwa G. Laparoscopic esophageal myotomy versus pneumatic dilation in the treatment of idiopathic achalasia: a meta-analysis of randomized controlled trials. Clin Exp Gastroenterol 2017; 10:241-248. [PMID: 29026325 PMCID: PMC5627730 DOI: 10.2147/ceg.s130449] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Achalasia is a primary esophageal motility disorder of unknown etiology associated with abnormalities in peristalsis and lower esophageal sphincter relaxation. The disease is incurable; however, definitive treatment procedures like pneumatic dilation (PD)/balloon dilation and laparoscopic esophageal myotomy (LEM) are performed to relieve dysphagia and related symptoms. Currently, there is paucity of data comparing the outcomes of these procedures. The aim of this meta-analysis is to compare the short- and long-term success rates of PD and LEM. METHODS A thorough systematic search of PubMed, Scopus, clinicaltrials.gov, and Cochrane library was conducted for randomized controlled trials (RCTs) comparing the outcomes of PD versus LEM in the treatment of achalasia. The Mantel-Haenszel method and random effect model were used to analyze the data. RCTs with outcome data at 3-month, 1-year, and 5-year intervals were analyzed. RESULTS A total of 437,378 and 254 patients at 3-month, 1-year, and 5-year intervals were analyzed for outcome data. At 3 months and 1 year, PD was not as effective as LEM (odds ratio [OR]: 0.50; confidence interval [CI] 0.31-0.82; P = 0.009 and OR: 0.47; CI 0.22-0.99; P = 0.21) but at 5 years, one procedure was non-inferior to the other (OR: 0.62; 0.33-1.19; P = 0.34). CONCLUSION PD was as effective as LEM in relieving symptoms of achalasia in the long-term.
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Affiliation(s)
- Ramkaji Baniya
- Department of Internal Medicine, Hurley Medical Center, Michigan State University, Flint, MI, USA
| | - Sunil Upadhaya
- Department of Internal Medicine, Hurley Medical Center, Michigan State University, Flint, MI, USA
| | - Jahangir Khan
- Department of Internal Medicine, Hurley Medical Center, Michigan State University, Flint, MI, USA
| | - Suresh Kumar Subedi
- Department of Internal Medicine, Hurley Medical Center, Michigan State University, Flint, MI, USA
| | - Tabrez Shaik Mohammed
- Department of Internal Medicine, Hurley Medical Center, Michigan State University, Flint, MI, USA
| | - Balvant K Ganatra
- Department of Internal Medicine, Hurley Medical Center, Michigan State University, Flint, MI, USA
| | - Ghassan Bachuwa
- Department of Internal Medicine, Hurley Medical Center, Michigan State University, Flint, MI, USA
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Herbella FA, Moura EG, Patti MG. Achalasia 2016: Treatment Alternatives. J Laparoendosc Adv Surg Tech A 2017; 27:6-11. [DOI: 10.1089/lap.2016.0468] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Fernando A.M. Herbella
- Department of Surgery, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil
| | - Eduardo G.H. Moura
- Department of Gastroenterology, University of São Paulo, São Paulo, Brazil
| | - Marco G. Patti
- Department of Surgery, University of North Carolina, Chapel Hill, North Carolina
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Affiliation(s)
- Puja S Elias
- Department of Gastroenterology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Donald Castell
- Esophageal Disorders Program, Medical University of South Carolina, Charleston, South Carolina, USA
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Response to Elias and Castell. Am J Gastroenterol 2016; 111:1362-3. [PMID: 27580785 DOI: 10.1038/ajg.2016.280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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