Expert consensus document: Advances in the management of oesophageal motility disorders in the era of high-resolution manometry: a focus on achalasia syndromes.
- Kahrilas PJ Northwestern University, Feinberg School of Medicine, Department of Medicine, 676 St Clair Street, 14th floor, Chicago, Illinois 60611-2951, USA.
- Bredenoord AJ Academic Medical Centre, Department of Gastroenterology and Hepatology, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
- Fox M Abdominal Center: Gastroenterology, St. Claraspital, Basel, Switzerland and Clinic for Gastroenterology & Hepatology, University Hospital Zürich, Zürich, Switzerland.
- Gyawali CP Washington University, Division of Gastroenterology, 660 S. Euclid Ave, Campus BOX 8124, St. Louis, Missouri 63110, USA.
- Roman S Digestive Physiology, Hospices Civils de Lyon and Lyon I university Edouard Herriot Hospital, Pavillon L, 5 place d'Arsonval, 69437 Lyon cedex 03, France.
- Smout AJPM Academic Medical Centre, Department of Gastroenterology and Hepatology, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
- Pandolfino JE Northwestern University, Feinberg School of Medicine, Department of Medicine, 676 St Clair Street, 14th floor, Chicago, Illinois 60611-2951, USA.
- 2017-09-28
Published in:
- Nature reviews. Gastroenterology & hepatology. - 2017
English
High-resolution manometry (HRM) and new analysis algorithms, summarized in the Chicago Classification, have led to a restructured classification of oesophageal motility disorders. This advance has led to increased detection of clinically relevant disorders, in particular achalasia. It has become apparent that the cardinal feature of achalasia - impaired lower oesophageal sphincter (LES) relaxation - can occur in several disease phenotypes: without peristalsis (type I), with pan-oesophageal pressurization (type II), with premature (spastic) distal oesophageal contractions (type III), or with preserved peristalsis (outlet obstruction). Furthermore, no manometric pattern is perfectly sensitive or specific for achalasia caused by a myenteric plexopathy, and there is no biomarker for this pathology. Consequently, physiological testing reveals other syndromes not meeting achalasia criteria that also benefit from therapies formerly reserved for achalasia. These findings have become particularly relevant with the development of a minimally invasive technique for performing a long oesophageal myotomy, the per-oral endoscopic myotomy (POEM). Optimal management is to render treatment in a phenotype-specific manner; that is, POEM calibrated to patient-specific physiology for spastic achalasia and the spastic disorders, and more conservative strategies such as pneumatic dilation for the disorders limited to the LES. This Consensus Statement examines the effect of HRM on our understanding of oesophageal motility disorders, with a focus on the diagnosis, epidemiology and management of achalasia and achalasia-like syndromes.
- Language
-
- English
- Open access status
- hybrid
- Identifiers
-
- DOI 10.1038/nrgastro.2017.132
- PMID 28951579
- Persistent URL
- https://sonar.ch/global/documents/88309
Statistics
Document views: 18
File downloads:
- fulltext.pdf: 0