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Achalasia: A review of Western and Iranian experiences

Mikaeli, J. and Islami, F. and Malekzadeh, R. (2009) Achalasia: A review of Western and Iranian experiences. World Journal of Gastroenterology, 15 (40). pp. 5000-5009.

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Abstract

Achalasia is a primary motor disorder of the esophagus, in which esophageal emptying is impaired. Diagnosis of achalasia is based on clinical findings. The diagnosis is confirmed by radiographic, endoscopic, and manometric evaluations. Several treatments for achalasia have been introduced. We searched the PubMed Database for original articles and meta-analyses about achalasia to summarize the current knowledge regarding this disease, with particular focus on different procedures that are used for treatment of achalasia. We also report the Iranian experience of treatment of this disease, since it could be considered as a model for medium-resource countries. Myotomy, particularly laparoscopic myotomy with fundoplication, is the most effective treatment for achalasia. Compared to other treatments, however, the initial cost of myotomy is usually higher and the recovery period is longer. When performing myotomy is not indicated or not possible, graded pneumatic dilation with slow rate of balloon inflation seems to be an effective and safe initial alternative. Injection of botulinum toxin into the lower esophageal sphincter before pneumatic dilation may increase remission rates. However, this needs to be confirmed in further studies. Due to lack of adequate information regarding the role of expandable stents in the treatment of achalasia, insertion of stents does not currently seem to be a recommended treatment. In summary, laparoscopic myotomy can be considered as the procedure of choice for treatment of achalasia. Graded pneumatic dilation is an effective alternative when the performance of myotomy is not possible for any reason. © 2009 The WJG Press and Baishideng. All rights reserved.

Item Type: Article
Additional Information: cited By 12
Uncontrolled Keywords: botulinum toxin; botulinum toxin A; nifedipine; nitrate, amyloidosis; balloon dilatation; carcinoma; causal attribution; Chagas disease; clinical trial; coughing; drug induced headache; drug megadose; dysphagia; endoscopy; eosinophilic gastroenteritis; esophagus achalasia; esophagus manometry; Fabry disease; gastroesophageal reflux; heartburn; hiccup; human; hypotension; intestine pseudoobstruction; Iran; laparoscopic surgery; lower esophagus sphincter; multiple endocrine neoplasia; myotomy; neurofibromatosis; paroxysmal dyspnea; pathophysiology; prevalence; review; side effect; Sjoegren syndrome; stent; stomach fundoplication; symptomatology; tachyphylaxis; thorax pain; thorax radiography; weight reduction, Adult; Balloon Dilatation; Esophageal Achalasia; Esophageal Diseases; Esophagus; Female; Fundoplication; Gastroenterology; Humans; Iran; Male; Middle Aged; Remission Induction; Risk; Stents; Treatment Outcome
Subjects: کهورت
مقالات نمایه شده محققین دانشگاه در سایت ,Web of Science ,Scopus
موارد کلی
Divisions: معاونت تحقیقات و فناوری
Depositing User: GOUMS
Date Deposited: 21 Apr 2015 10:06
Last Modified: 01 Mar 2017 06:41
URI: http://eprints.goums.ac.ir/id/eprint/2602

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