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  1. Fulltext Bridging the gap between advancements in the evolution of diagnosis and treatment towards better outcomes in achalasia
    Chuah SK, Lim CS, Liang CM, Lu HI, Wu KL, Changchien CS, et al.
    Biomed Res Int, 2019;2019:8549187.
    PMID: 30881999 DOI: 10.1155/2019/8549187
    Over the past few decades, there was an encouraging breakthrough in bridging the gap between advancements in the evolution of diagnosis and treatment towards a better outcome in achalasia. The purpose of this review is to provide updated knowledge on how the current evidence has bridged the gap between advancements in the evolution of diagnosis and treatment of esophageal achalasia. The advent of high-resolution manometry and standardization based on the Chicago classification has increased early recognition of the disease. These 3 clinical subtypes of achalasia can predict the outcomes of patients, and the introduction of POEM has revolutionized the choice of treatment. Previous evidence has shown that laparoscopic Heller myotomy (LHM) and anterior fundoplication were considered the most durable treatments for achalasia. Based on the current evidence, POEM has been evolving as a promising strategy and is effective against all 3 types of achalasia, but the efficacy of POEM is based on short- and medium-term outcome studies from a limited number of centers. Types I and II achalasia respond well to POEM, LHM, and PD, while most studies have shown that type III achalasia responds better to POEM than to LHM and PD. In general, among the 3 subtypes of achalasia, type II achalasia has the most favorable outcomes after medical or surgical therapies. The long-term efficacy of POEM is still unknown. The novel ENDOFLIP measures the changes in intraoperative esophagogastric junction dispensability, which enables a quantitative assessment of luminal patency and sphincter distension; however, this technology is in its infancy with little data to date supporting its intraoperative use. In the future, identifying immunomodulatory drugs and the advent of stem cell therapeutic treatments, including theoretically transplanting neuronal stem cells, may achieve a functional cure. In summary, it is important to identify the clinical subtype of achalasia to initiate target therapy for these patients.
    Matched MeSH terms: Esophageal Achalasia/diagnosis*
  2. Clinical Spectrum of Esophageal Motility Disorders in Nonobstructive Dysphagia: A Multicenter, Multiethnic Study
    Lim JX, Prasad R, Izham N, Chan WL, Ramasami N, Wong WJ, et al.
    J Gastroenterol Hepatol, 2026 Nov;41(11):3405-3412.
    PMID: 42710884 DOI: 10.1111/jgh.70713
    BACKGROUND AND AIMS: Nonobstructive dysphagia (NOD) is a frequently encountered condition. The spectrum of underlying esophageal motility disorders remains incompletely characterized in Asian populations. We aimed to define the manometric spectrum of NOD, identify predictors of achalasia, and evaluate the diagnostic value of provocative testing.

    METHODS: This retrospective multicenter study included adults who underwent high-resolution manometry (HRM) for NOD at two tertiary hospitals in Malaysia from 2014 to 2023. Diagnoses were classified according to Chicago Classification v3.0. Clinical predictors of achalasia were evaluated. The discriminatory performance of rapid drink challenge (RDC)-integrated relaxation pressure (IRP) in differentiating achalasia from non-achalasia was explored.

    RESULTS: Among 230 patients (mean age 53.3; 47.0% male), achalasia was identified in 23.9%, esophagogastric junction outflow obstruction (EGJOO) in 17.3%, and ineffective esophageal motility in 24.8%. Weight loss (adjusted OR 2.99, 95% CI 1.25-7.15, p = 0.014), absence of dyspepsia (adjusted OR 0.09, 95% CI 0.02-0.45, p = 0.004), and presence of nausea/vomiting (adjusted OR 3.35, 95% CI 1.34-8.40, p = 0.010) independently predicted achalasia. RDC-IRP demonstrated strong discrimination between achalasia and non-achalasia (AUC 0.894, 95% CI 0.794-0.993, p Achalasia constitutes a substantial proportion of patients evaluated for NOD in tertiary care settings. Specific clinical features may aid early recognition. RDC may provide incremental diagnostic value and may serve as a practical adjunctive tool in differentiating achalasia from EGJOO.

    Matched MeSH terms: Esophageal Achalasia/diagnosis
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