Diagnosis and treatment of achalasia — a review of foreign literature

Abstract

Introduction. The interest in achalasia has signifi cantly increased with the advent of new methods for the diagnosis and treatment of this disease. New methods are introduced several years earlier abroad than in Russia, prospective randomized trials are conducted more often, based on the results of which clinical recommendations are established. Therefore, the authors of this article provide an extensive review of foreign literature devoted to the diagnosis and treatment of achalasia, which refl ects not only current trends, but also those areas to which researchers of past years paid attention.Results. Traditional and new diagnostic methods (timed barium swallow and high-resolution manometry) are described. The Chicago classifi cation of esophageal motility disorders version 3.0 is given. The whole spectrum of treatment of esophageal achalasia — conservative and surgical methods with analysis of immediate and long-term results, including the comparison of these methods and with the combined use of several techniques in one patient is presented. The complex problem of choosing a treatment method for the end-stage achalasia is considered. For key points in diagnosing and treating the disease, clinical guidelines on achalasia published in 2020 (European Guideline on Achalasia — UEG and ESNM recommendations) are presented.Conclusion. Esophageal achalasia is a chronic disease, for the treatment of which there is still no consensus. Balloon pneumatic dilation, peroral endoscopic myotomy and laparoscopic Heller myotomy with fundoplication are safe and highly eff ective and can be recommended for the treatment of achalasia. Currently, there is a gradual transition to a less invasive initial treatment of the end-stage achalasia, but large multicenter and randomized clinical trials are necessary to obtain fi nal data on various treatment options.