Achalasia natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1], Associate Editor(s)-in-Chief: Ahmed Younes M.B.B.CH [2]
Overview
If left untreated, the disease can progress causing complications such as candida esophagitis and esophageal perforation. However, achalasia does not alter the lifespan of the patients. Common complications include GERD, Barrett's esophagus, and aspiration pneumonia. The prognosis is good with cure rate of 60-90% after surgical interventions.
Natural History
- The disease has a slow onset of symptoms, therefore the condition is usually advanced at the time of presentation.[1]
- If left untreated, the disease can progress causing complications such as candida esophagitis, esophageal perforation and aspiration pneumonia. However, achalasia does not alter the lifespan of the patients.[1]
Complications
Achalasia may be complicated by
- Gastroesophageal reflux disease (GERD) or heartburn.
- Achalasia patients have an increased risk of developing Barrett's esophagus or Barrett's mucosa, a premalignant condition which may lead to esophageal cancer over a period of years.[2]
- Aspiration pneumonia: Food and liquid, including saliva, are retained in the esophagus and may be inhaled into the lungs, especially while sleeping in a horizontal position.
- Tearing (perforation) of the esophagus[3]
- The incidence of esophageal cancer is controversial in patients with achalasia. Some Swedish studies report an increased incidence and suggest routine surveillance esophagogastroduodenoscopy (EGD). This has not been shown to be the case in the U.S.A., and current recommendations do not include routine EGD.[4]
Prognosis
- With treatment, the outcome for achalasia is usually good.
- The cure rate ranges from 60 to 90% after surgical interventions.[5]
References
- ↑ 1.0 1.1 ELLIS FG (1960). "The natural history of achalasia of the cardia". Proc. R. Soc. Med. 53: 663–6. PMC 1869428. PMID 13820027.
- ↑ Sawyers JL, Foster JH (1967). "Surgical considerations in the management of achalasia of the esophagus". Ann. Surg. 165 (5): 780–5. PMC 1617585. PMID 6023934.
- ↑ Pandolfino JE, Kwiatek MA, Nealis T, Bulsiewicz W, Post J, Kahrilas PJ (2008). "Achalasia: a new clinically relevant classification by high-resolution manometry". Gastroenterology. 135 (5): 1526–33. doi:10.1053/j.gastro.2008.07.022. PMC 2894987. PMID 18722376.
- ↑ Howard PJ, Maher L, Pryde A, Cameron EW, Heading RC (1992). "Five year prospective study of the incidence, clinical features, and diagnosis of achalasia in Edinburgh". Gut. 33 (8): 1011–5. PMC 1379432. PMID 1398223.
- ↑ Furuzawa-Carballeda J, Torres-Landa S, Valdovinos MÁ, Coss-Adame E, Martín Del Campo LA, Torres-Villalobos G (2016). "New insights into the pathophysiology of achalasia and implications for future treatment". World J. Gastroenterol. 22 (35): 7892–907. doi:10.3748/wjg.v22.i35.7892. PMC 5028805. PMID 27672286.