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Título del libro: Clinical And Basic Neurogastroenterology And Motility
Título del capítulo: Achalasia

Autores UNAM:
MIGUEL ANGEL VALDOVINOS DIAZ;
Autores externos:

Idioma:

Año de publicación:
2019
Palabras clave:

Achalasia; Botulinum toxin; Esophageal motility disorder; High-resolution manometry; Myotomy; Pneumatic dilation; POEM


Resumen:

Achalasia is a major esophageal motility disorder characterized by loss of esophageal peristalsis and incomplete relaxation of the lower esophageal sphincter (LES). The etiology of achalasia is unknown. Genetic susceptibility, viral infection, immune-mediated inflammation and neurodegenerative factors are the pathophysiologic mechanisms of this disorder, resulting in loss of inhibitory neurons in the myenteric plexus of the esophagus. Dysphagia for liquids and solids, regurgitation, weight loss, chest pain and aspiration are the principal clinical manifestations. High-resolution esophageal manometry (HRM) is the gold standard diagnostic test. Three clinical phenotypes have been recognized by HRM. Subtype II of achalasia is the phenotype with the best response rate to any therapeutic intervention. Pneumatic dilatation, laparoscopic Heller myotomy and peroral endoscopic myotomy (POEM) are the most efficacious therapeutic modalities. There is a moderate increased risk to develop esophageal carcinoma in patients with achalasia after 10 years of symptom onset. © 2020 Elsevier Inc. All rights reserved.


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