Pneumatic Dilatation for the Treatment of Achalasia

Abstract: A peristalsis of the esophageal body and absent or incomplete lower esophageal sphincter (LES) relaxation on swallowing are the functional hallmarks of achalasia. Its pathogenesis involves loss of intramural neurons, a process that subsequently results in poor LES relaxation and dilatation of the esophageal body. No logical therapeutic concept can be formulated since the cause of this disorder is at present poorly understood. Treatment focuses on pharmacological or mechanical alleviation of LES obstruction. Medical treatment of achalasia has yielded only limited success compared with mechanical dilatation or surgical myotomy. There is no question that pneumatic dilatation is the most effective, nonsurgical treatment available for the management of achalasia. If patients are at low risk, regarding age and cardiorespiratory status, pneumatic dilatation should be considered as the treatment of choice. Repeated dilatations result in a progressively longer remission. Peristaltic sequences may return in response to successful dilatation. It is important to distinguish primary from secondary achalasia as the therapy and prognosis of the two conditions are distinctly different. An endoscopy can demonstrate the absence of organic lesions, especially carcinoma or esophagitis. Achalasia during pregnancy is safely managed by endoscopic dilatation and it does not constitute an indication for the termination of the pregnancy. A major objective of this article is to provide some insight into the usage patterns, results, and complications associated with pneumatic dilatation of achalasia.