GASTROENTEROLOGY ARTICLE OF THE WEEK
October 30, 2008
Richter JE. A young man with a new diagnosis of achalasia. Clin Gastroenterol Hepatol 2008;6:859-863.
1. Risk factors for symptom recurrence after balloon dilation for achalasia include
a. Age <40 years
b. female sex
c. Max dilator size of 3.0cm
d. Residual LES pressure >10mmHg
True or False
2. Achalasia is equally prevalent in males and females
3. The medical literature indicates better outcomes with surgical therapy compared to balloon dilation in achalasia.
4. Heartburn is extremely uncommon in achalasia, and when present, is a strong argument against the diagnosis
5. Barrett’s esophagus is a known complication of Heller myotomy
6. Older patients over age 60 respond best to botox, sustained response is possible after several sessions.
7. The lack of VIP in the esophageal body explains the absence of organized peristalsis
8. After Heller myotomy, close to 20% of patients may require re-treatment after 10 years or so
9. The pathophysiology of achalasia includes a selective loss of cholinergic stimulation to the LES
10. Perforation rates with balloon dilation for achalsia are 1 – 3%
11. Perforation rates with Heller myotomy are 7%-15%, higher in patients with prior botox therapy
12. If a patient has suboptimal relief after treatment with the usual dose of 100 U Botulinum toxin, repeat treatment should be done with 200 U of toxin