Evidence-Based Treatment for a Patient with Achalasia_Chinese Journal of Evidence-Based Medicine

Authors：

 LIU Qisheng ^1,2 , DONG Weiguo ²

1. Department of Gastroenterology, Centre Hospital of Xianning, Xianning 437100, China;2. Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan 430060, China;

Corresponding author：

LIU Qisheng, Email: liuqisheng99@yahoo.com.cn

Keywords：

Achalasia; Evidence-based therapy

DOI：

10.7507/1672-2531.20120076

Video：

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Objective 　Through the methods of evidence-based medicine, to make an individualized treatment plan for a patient with achalasia.
Methods 　Based on an adequate assessment of the patient’s condition, clinical issues aimed at this case were put forward. And the best clinical evidence related to achalasia treatment was evaluated after being retrieved from The Cochrane library (1990 to 2010) and PubMed (1980 to 2010).
Results 　33 studies were retrieved including 29 RCTs and 4 systematic reviews. The efficacy and safety of drug therapy, endoscopic injection of botulinum, endoscopic balloon dilatation and surgical therapy were evaluated. Cosidering symptoms,age and comorbidities, we recommended endoscopic balloon dilatation or laparoscopic Heller postoperative plus Dor fundoplication surgery for treatment. The patient’s choice is endoscopic balloon dilatation. Symptoms of patient were relieved after treatment.
Conclusion 　Making a rational therapeutic plan for achalasia patients by means of evidence-based treatment not only can improve therapeutic effect but also be beneficial for both doctors and patients to share uncertain risks.

Citation： LIU Qisheng,DONG Weiguo. Evidence-Based Treatment for a Patient with Achalasia. Chinese Journal of Evidence-Based Medicine, 2012, 12(4): 489-494. doi: 10.7507/1672-2531.20120076 Copy

1.	Sonnenberg A. Hospitalization for achalasia in the United States 1997-2006. Dig Dis Sci, 2009, 54(8): 1680-1685.
2.	Wen ZH, Gardener E, Wang YP.Nitrates for achalasia. Cochrane Database Syst Rev, 2004(1): CD002299.
3.	Nasrallah SM, Tommaso CL, Singleton RT, et al. Primary esophageal motor disorders: clinical response to nifedipine. South Med J, 1985, 78(3): 312-315.
4.	Traube M, Dubovik S, Lange RC, et al. The role of nifedipine therapy in achalasia: results of a randomized, double-blind, placebo-controlled study. Am J Gastroenterol, 1989, 84(10): 1259-1562.
5.	Bortolotti M, Mari C, Lopilato C, et al. Effects of sildenafil on esophageal motility of patients with idiopathic achalasia. Gastroenterology, 2000, 118(2): 253-257.
6.	Pasricha PJ, Ravich WJ, Hendrix TR, et al. Intrasphincteric botulinum toxin for the treatment of achalasia. N Engl J Med, 1995, 332(12): 774-778.
7.	Kolbasnik J, Waterfall WE, Fachnie B, et al. Long-term efficacy of Botulinum toxin in classical achalasia: a prospective study. Am J Gastroenterol, 1999, 94(12): 3434-3439.
8.	D’Onofrio V, Annese V, Miletto P, et al. Long-term follow-up of achalasia patients treated with botulinum toxin. Dig Liver Dis, 2002, 34(2): 105-110.
9.	Muehldorfer SM, Hahn EG, Ell C. High- and low-compliance balloon dilators in patients with achalasia: a randomized prospective comparative trial. Gastrointest Endosc, 1996, 44(4): 398-403.
10.	Gideon RM, Castell DO, Yarze J. Prospective randomized comparison of pneumatic dilatation technique in patients with idiopathic achalasia. Dig Dis Sci, 1999, 44(9): 1853-1857.
11.	Mikaeli J, Fazel A, Montazeri G, et al. Randomized controlled trial comparing botulinum toxin injection to pneumatic dilatation for the treatment of achalasia. Aliment Pharmacol Ther, 2001, 15(9): 1389-1396.
12.	Falkenback D, Johansson J, Oberg S, et al. Heller’s esophagomyotomy with or without a 360 degrees floppy Nissen fundoplication for achalasia. Long-term results from a prospective randomized study. Dis Esophagus, 2003. 16(4): 284-290.
13.	Richards WO, Torquati A, Holzman MD, et al. Heller myotomy versus Heller myotomy with Dor fundoplication for achalasia: a prospective randomized double-blind clinical trial. Ann Surg, 2004, 240(3): 405-412; discussion 412-415.
14.	Ramacciato G, Mercantini P, Amodio PM, et al. The laparoscopic approach with antireflux surgery is superior to the thoracoscopic approach for the treatment of esophageal achalasia. Experience of a single surgical unit. Surg Endosc, 2002, 16(10): 1431-1437.
15.	Patti MG, Arcerito M, De Pinto M, et al. Comparison of thoracoscopic and laparoscopic Heller myotomy for achalasia. J Gastrointest Surg, 1998, 2(6): 561-566.
16.	Mikaeli J, Yaghoobi M, Montazeri G, et al. Efficacy of botulinum toxin injection before pneumatic dilatation in patients with idiopathic achalasia. Dis Esophagus, 2004, 17(3): 213-217.
17.	Campos GM, Vittinghoff E, Rabl C, et al. Endoscopic and surgical treatments for achalasia: a systematic review and meta-analysis. Ann Surg, 2009, 249(1): 45-57.
18.	Wang L, Li YM, Li L. Meta-analysis of randomized and controlled treatment trials for achalasia. Dig Dis Sci, 2009, 54(11): 2303-2311.
19.	Wang L, Li YM, Li L, et al. A systematic review and meta-analysis of the Chinese literature for the treatment of achalasia. World J Gastroenterol, 2008, 14(38): 5900-5906.
20.	Karanicolas PJ, Smith SE, Inculet RI, et al. The cost of laparoscopic myotomy versus pneumatic dilatation for esophageal achalasia. Surg Endosc, 2007, 21(7): 1198-1206.
21.	Kostic S, Johnsson E, Kjellin A, et al. Health economic evaluation of therapeutic strategies in patients with idiopathic achalasia: results of a randomized trial comparing pneumatic dilatation with laparoscopic cardiomyotomy. Surg Endosc, 2007, 21(7): 1184-1189.
22.	Imperiale TF, O’Connor JB, Vaezi MF, et al. A cost-minimization analysis of alternative treatment strategies for achalasia. Am J Gastroenterol, 2000, 95(10): 2737-2745.

1. Sonnenberg A. Hospitalization for achalasia in the United States 1997-2006. Dig Dis Sci, 2009, 54(8): 1680-1685.
2. Wen ZH, Gardener E, Wang YP.Nitrates for achalasia. Cochrane Database Syst Rev, 2004(1): CD002299.
3. Nasrallah SM, Tommaso CL, Singleton RT, et al. Primary esophageal motor disorders: clinical response to nifedipine. South Med J, 1985, 78(3): 312-315.
4. Traube M, Dubovik S, Lange RC, et al. The role of nifedipine therapy in achalasia: results of a randomized, double-blind, placebo-controlled study. Am J Gastroenterol, 1989, 84(10): 1259-1562.
5. Bortolotti M, Mari C, Lopilato C, et al. Effects of sildenafil on esophageal motility of patients with idiopathic achalasia. Gastroenterology, 2000, 118(2): 253-257.
6. Pasricha PJ, Ravich WJ, Hendrix TR, et al. Intrasphincteric botulinum toxin for the treatment of achalasia. N Engl J Med, 1995, 332(12): 774-778.
7. Kolbasnik J, Waterfall WE, Fachnie B, et al. Long-term efficacy of Botulinum toxin in classical achalasia: a prospective study. Am J Gastroenterol, 1999, 94(12): 3434-3439.
8. D’Onofrio V, Annese V, Miletto P, et al. Long-term follow-up of achalasia patients treated with botulinum toxin. Dig Liver Dis, 2002, 34(2): 105-110.
9. Muehldorfer SM, Hahn EG, Ell C. High- and low-compliance balloon dilators in patients with achalasia: a randomized prospective comparative trial. Gastrointest Endosc, 1996, 44(4): 398-403.
10. Gideon RM, Castell DO, Yarze J. Prospective randomized comparison of pneumatic dilatation technique in patients with idiopathic achalasia. Dig Dis Sci, 1999, 44(9): 1853-1857.
11. Mikaeli J, Fazel A, Montazeri G, et al. Randomized controlled trial comparing botulinum toxin injection to pneumatic dilatation for the treatment of achalasia. Aliment Pharmacol Ther, 2001, 15(9): 1389-1396.
12. Falkenback D, Johansson J, Oberg S, et al. Heller’s esophagomyotomy with or without a 360 degrees floppy Nissen fundoplication for achalasia. Long-term results from a prospective randomized study. Dis Esophagus, 2003. 16(4): 284-290.
13. Richards WO, Torquati A, Holzman MD, et al. Heller myotomy versus Heller myotomy with Dor fundoplication for achalasia: a prospective randomized double-blind clinical trial. Ann Surg, 2004, 240(3): 405-412; discussion 412-415.
14. Ramacciato G, Mercantini P, Amodio PM, et al. The laparoscopic approach with antireflux surgery is superior to the thoracoscopic approach for the treatment of esophageal achalasia. Experience of a single surgical unit. Surg Endosc, 2002, 16(10): 1431-1437.
15. Patti MG, Arcerito M, De Pinto M, et al. Comparison of thoracoscopic and laparoscopic Heller myotomy for achalasia. J Gastrointest Surg, 1998, 2(6): 561-566.
16. Mikaeli J, Yaghoobi M, Montazeri G, et al. Efficacy of botulinum toxin injection before pneumatic dilatation in patients with idiopathic achalasia. Dis Esophagus, 2004, 17(3): 213-217.
17. Campos GM, Vittinghoff E, Rabl C, et al. Endoscopic and surgical treatments for achalasia: a systematic review and meta-analysis. Ann Surg, 2009, 249(1): 45-57.
18. Wang L, Li YM, Li L. Meta-analysis of randomized and controlled treatment trials for achalasia. Dig Dis Sci, 2009, 54(11): 2303-2311.
19. Wang L, Li YM, Li L, et al. A systematic review and meta-analysis of the Chinese literature for the treatment of achalasia. World J Gastroenterol, 2008, 14(38): 5900-5906.
20. Karanicolas PJ, Smith SE, Inculet RI, et al. The cost of laparoscopic myotomy versus pneumatic dilatation for esophageal achalasia. Surg Endosc, 2007, 21(7): 1198-1206.
21. Kostic S, Johnsson E, Kjellin A, et al. Health economic evaluation of therapeutic strategies in patients with idiopathic achalasia: results of a randomized trial comparing pneumatic dilatation with laparoscopic cardiomyotomy. Surg Endosc, 2007, 21(7): 1184-1189.
22. Imperiale TF, O’Connor JB, Vaezi MF, et al. A cost-minimization analysis of alternative treatment strategies for achalasia. Am J Gastroenterol, 2000, 95(10): 2737-2745.

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