Achalasia: Diagnosis and Treatment by P. Marco Fisichella, Fernando A. M. Herbella, Marco G. Patti

By P. Marco Fisichella, Fernando A. M. Herbella, Marco G. Patti

every one bankruptcy describes a truly particular element of Achalasia through its recognized specialist. present diagnostic and administration suggestions of Achalasia, in addition to the simplified operative techniques with appropriate technical concerns, are defined for the explicit aim audience.

The remedy of Achalasia is advanced and customarily played in really expert tertiary-care centres. The Editors' major objective is to render this sickness extra comprehensible and available to citizens, fellows, and experts in either the surgical disciplines (general surgical procedure and thoracic surgical procedure) and in gastroenterology.

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Additional info for Achalasia: Diagnosis and Treatment

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0 cm (Adapted by permission from Richter and Roberts [6]) dilator was the first dilator to be available in a number of sizes and consisted of a dumbbellshaped bag that could be positioned across the GEJ via guidewire placement.

The 24-h pH monitoring should be obtained also in patients who had undergone a previous endoscopic balloon dilatation for two reasons: (1) reflux is often asymptomatic and exposes untreated patients to a higher risk of Barrett’s esophagus or cancer; and (2) in case of persistent or recurrent dysphagia, further endoscopic dilatations should be avoided and a Heller myotomy with antireflux surgery should be considered [21]. Postoperatively, ambulatory pH monitoring should be routinely performed even in asymptomatic patients to rule out reflux, which is present in roughly 10–30 % of cases after Heller myotomy [22].

5 Botulinum Toxin for Achalasia Hiroshi Mashimo Introduction Botulinum neurotoxin (BoNT) is one of the most potent toxins known, with a median human lethal dose of 1–2 ng when injected. However, its effect as a neurotoxin has been employed to treat spasms, hyperhidrosis, migraine, and various pain syndromes. It is also widely used for cosmetic treatments. Off-label gastrointestinal uses include treatment of gastroparesis, anal fissures, anismus, sphincter of Oddi dysfunction, and esophageal dysmotility.

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