ACALASIA

Achalasia is a primary esophageal motility disorder that has been reported in the literature as a rare disease. The current clinical dilemma is mainly due to its poorly elucidated pathogenesis. Numerous heterogeneous studies have shown that this condition is caused by neurodegeneration of the lower esophageal sphincter, the precipitating factors of which are genetic abnormalities, viral infection, as well as inflammation and immunity. Although the diagnosis is eminently clinical, this method is not sufficient to distinguish it from other esophageal diseases; therefore, it must be confirmed with other diagnostic tests, such as digestive endoscopy, contrasted radiological study and manometry. Advanced high-resolution technologies are now being used to help predict the outcome or select more appropriate therapeutic procedures. Management of this condition consists mainly of improving esophageal outflow to provide symptomatic relief to patients. The most effective treatment options include pneumatic dilatation, Heller myotomy and peroral endoscopic myotomy (POEM); the latter increasingly stands out as the therapeutic of choice for many patients.