Diagnóstico y manejo actual de la acalasia

Autores/as

DOI:

https://doi.org/10.30944/20117582.2187

Palabras clave:

trastornos de deglución, acalasia del esófago, manometría, clasificación, miotomía de Heller

Resumen

Introducción. La acalasia es un trastorno motor del esófago poco común, de etiología no clara, caracterizado por la pérdida de relajación del esfínter esofágico inferior, pérdida del peristaltismo normal, regurgitación y disfagia.

Métodos. Se realizó una revisión narrativa de la literatura en revistas científicas y bases de datos en español e inglés, con el fin de presentar información actualizada en lo referente al diagnóstico y tratamiento de esta patología.

Resultado. Se presenta la actualización de los criterios de los trastornos motores esofágicos según la clasificación de Chicago (CCv4.0) para el diagnóstico de acalasia y sus subtipos de acuerdo con los nuevos criterios, así como los tratamientos actuales.

Conclusión. La acalasia es un trastorno esofágico multimodal, con manifestaciones de predominio gastrointestinal, por lo que su diagnóstico y abordaje terapéutico oportuno es esencial para mejorar la calidad de vida de los pacientes.

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Biografía del autor/a

Bryan Nicolás Forero-Vásquez, Universidad de Ciencias Aplicadas y Ambientales U.D.C.A, Bogotá, D.C., Colombia.

Estudiante de medicina.

Jeisón Javier Yopasa-Romero, Universidad de Ciencias Aplicadas y Ambientales U.D.C.A, Bogotá, D.C., Colombia.

Estudiante de medicina.

Referencias bibliográficas

Khashab MA, Vela MF, Thosani N, Agrawal D, Buxbaum JL, Abbas-Fehmi SM, et al. ASGE guideline on the management of achalasia. Gastrointest Endosc. 2020;91:213- 227.e6. https://doi.org/10.1016/j.gie.2019.04.231

Samo S, Carlson DA, Gregory DL, Gawel SH, Pandolfino JE, Kahrilas PJ. Incidence and prevalence of achalasia in central Chicago, 2004–2014, since the widespread use of high-resolution manometry. Clin Gastroenterol Hepatol. 2017;15:366-73. http://dx.doi.org/10.1016/j.cgh.2016.08.030

Prieto RG, Prieto JE, Casas F, Ballén H. Acalasia, una visión actual. Rev Colomb Cir. 2019;34:171-8. https://doi.org/10.30944/20117582.111

Pandolfino JE, Gawron AJ. Achalasia: A systematic review. JAMA. 2015;313:1841-52. http://dx.doi.org/10.1001/jama.2015.2996

Furuzawa-Carballeda J, Torres-Landa S, Valdovinos MÁ, Coss-Adame E, Del Campo LAM, Torres-Villalobos G. New insights into the pathophysiology of achalasia and implications for future treatment. World J Gastroenterol. 2016;22:7892-907. http://dx.doi.org/10.3748/wjg.v22.i35.7892

Torresan F, Ioannou A, Azzaroli F, Bazzoli F. Treatment of achalasia in the era of high-resolution manometry. Ann Gastroenterol. 2015;28: 301-8.

Newberry C, Vajravelu RK, Pickett-Blakely O, Falk G, Yang YX, Lynch KL. Achalasia patients are at nutritional risk regardless of presenting weight category. Dig Dis Scien. 2018;63:1243-9. https://doi.org/10.1007/s10620-018-4985-8

Milito P, Aquilino K, Lazzari V, Boveri S, Munizio N, Ogliari C, et al. The malnutrition universal screening tool can predict malnutrition in patients with esophageal achalasia. Eur J Gastroenterol Hepatol. 2020;32:1135-40. https://doi.org/10.1097/MEG.0000000000001798

Jung DH, Park H. Is gastroesophageal reflux disease and achalasia coincident or not? J Neurogastroenterolog Motil. 2017;23:5-8. https://doi.org/10.5056/jnm16121

Pohl D, Tutuian R. Achalasia: an overview of diagnosis and treatment. J Gastrointestin Liver Dis. 2007;16:297-303.

Kessing BF, Bredenoord AJ, Smout AJPM. Erroneous diagnosis of gastroesophageal reflux disease in achalasia. Clin Gastroenterol Hepatol. 2011;9:1020-4. http://dx.doi.org/10.1016/j.cgh.2011.04.022

Khan A, Yadlapati R, Gonlachanvit S, Katzka DA, Park MI, Vaezi M, et al. Chicago Classification update (version 4.0): Technical review on diagnostic criteria for achalasia. Neurogastroenterolog Motil. 2021;33:1-9. https://doi.org/10.1111/nmo.14182

Castillo-León J, Pacheco-Barzallo F, Arias-Garzón W. Tratamiento actual de la acalasia, reporte de un caso y revisión de la literatura. Revista Metro Ciencia. 2016;24:25-30.

Kaths JM, Foltys DB, Scheuermann U, Strempel M, Niebisch S, Ebert M, et al. Achalasia with megaesophagus and tracheal compression in a young patient: A case report. Int J Surg Case Rep. 2015;14:16-8. http://dx.doi.org/10.1016/j.ijscr.2015.06.020

Borráez-Segura BA, Gómez DF, Meza JA, Oliveros R, Pinilla RE, Prieto RG, et al. Esofagograma: Imágenes que valen más que mil palabras. Rev Colomb Gastroenterol. 2017;32:258-68. https://doi.org/10.22516/25007440.157

Córdoba C, Rodil A, Cisternas D. Novedades acerca de los trastornos motores del esófago tras la reciente clasificación de chicago 4.0. Acta Gastroenterol Latinoam. 2021;51:131-42. https://doi.org/10.52787/hoho3531

Yadlapati R, Pandolfino JE, Fox MR, Bredenoord AJ, Kahrilas PJ. What is new in Chicago Classification version 4.0? Neurogastroenterol Motil. 2021;33:e14053. https://doi.org/10.1111/nmo.14053

Yadlapati R, Kahrilas PJ, Fox MR, Bredenoord AJ, Gyawali PC, Roman S, et al. Esophageal motility disorders on high-resolution manometry: Chicago classification version 4.0. Neurogastroenterol Motil. 2020;33:e14058. https://doi.org/10.1111/nmo.14058

Abubakar U, Bashir MB, Kesieme EB. Pseudoachalasia: A review. Niger J Clin Pract. 2016;19:303-7. https://doi.org/10.4103/1119-3077.179275

Ponds FA, van Raath MI, Mohamed SMM, Smout AJPM, Bredenoord AJ. Diagnostic features of malignancy-associated pseudoachalasia. Aliment Pharmacol Ther. 2017;45:1449-58. https://doi.org/10.1111/apt.14057

Schizas D, Theochari NA, Katsaros I, Mylonas KS, Triantafyllou T, Michalinos A, et al. Pseudoachalasia: a systematic review of the literature. Esophagus. 2020;17:216-22. https://doi.org/10.1007/s10388-020-00720-1

Jovanovic S, Djuric-Stefanovic A, Simić A, Skrobic O, Pesko P. Value of multidetector computed tomography in the assessment of achalasia subtypes and detection of pulmonary and thoracic complications. Med Princ Pract. 2019;28:539-46. https://doi.org/10.1159/000501057

Licurse MY, Levine MS, Torigian DA, Barbosa EM. Utility of chest CT for differentiating primary and secondary achalasia. Clin Radiol. 2014;69:1019-26. http://dx.doi.org/10.1016/j.crad.2014.05.005

Nurczyk K, Patti MG. Surgical management of achalasia. Ann Gastroenterolog Surg. 2020;4:343-51. https://doi.org/10.1002/ags3.12344

Paula DMP, Barbosa JP, Barbosa E, Barbosa J. Surgery outcomes and quality of life in achalasia’s treatment. J Laparoendosc Adv Surg Tech. 2020;30:1308-13. https://doi.org/10.1089/lap.2020.0186

Crespin OM, Tatum RP, Xiao K, Martin AV, Khandelwal S, Pellegrini CA, et al. The relationship between manometric subtype and outcomes of surgical treatment for patients with achalasia: Achalasia: manometric subtypes. Surg Endosc. 2017;31:5066-75. https://doi.org/10.1007/s00464-017-5570-5

Allaix ME, Patti MG. Endoscopic dilatation, Heller myotomy, and peroral endoscopic myotomy: treatment modalities for achalasia. Surg Clin North Am. 2015;95:567-78. http://dx.doi.org/10.1016/j.suc.2015.02.009

Gunasingam N, Perczuk A, Talbot M, Kaffes A, Saxena P. Update on therapeutic interventions for the management of achalasia. J Gastroenterol Hepatol. 2016;31:1422-8. https://doi.org/10.1111/jgh.13408

Kahrilas PJ, Pandolfino JE. Treatments for achalasia in 2017: How to choose among them. Curr Opin Gastroenterolog. 2017;33:270-6. https://doi.org/10.1097/MOG.0000000000000365

Nassri A, Ramzan Z. Pharmacotherapy for the management of achalasia: Current status, challenges and future directions. World J Gastrointest Pharmacol Ther. 2015;6:145-55. https://doi.org/10.4292/wjgpt.v6.i4.145

Kappelle WFW, Bogte A, Siersema PD. Hydraulic dilation with a shape-measuring balloon in idiopathic achalasia: A feasibility study. Endoscopy. 2015;47:1028-34. http://dx.doi.org/%0A10.1055/s-0034-1392481

Estremera-Arévalo F, Albéniz E, Rullán M, Areste I, Iglesias R, Vila JJ. Efficacy of peroral endoscopic myotomy compared with other invasive treatment options for the different esophageal motor disorders. Rev Esp Enf Dig. 2017;109:578-86. https://dx.doi.org/10.17235/reed.2017.4773/2016

Pasricha PJ, Hawari R, Ahmed I, Chen J, Cotton PB, Hawes HR, et al. Submucosal endoscopic esophageal myotomy: a novel experimental approach for the treatment of achalasia. Endoscopy. 2007;39:761-4. https://doi.org/10.1055/s-2007-966764

Hungness ES, Jorge JM. Per-Oral Esophageal Myotomy: Is it a safe and durable procedure for achalasia? Adv Surg. 2017;51:193-205. http://dx.doi.org/10.1016/j.yasu.2017.03.015

Schlottmann F, Luckett DJ, Fine J, Shaheen NJ, Patti MG. Laparoscopic Heller myotomy versus peroral endoscopic myotomy (POEM) for achalasia: a systematic review and meta-analysis. Ann Surg. 2018;267:451-60. https://doi.org/10.1097/SLA.0000000000002311

Cappell MS, Stavropoulos SN, Friedel D. Updated systematic review of achalasia, with a focus on POEM therapy. Dig Dis Sci. 2020;65:38-65. https://doi.org/10.1007/s10620-019-05784-3 37. Kahrilas PJ. Treating achalasia; more than just flipping a coin. Gut. 2016;65:726-7. https://doi.org/10.1136/gutjnl-2015-311016

Inoue H, Ueno A, Shimamura Y, Manolakis A, Sharma A, Kono S, et al. Peroral endoscopic myotomy and fundoplication: A novel NOTES procedure. Endoscopy. 2019;51:161-4. https://doi.org/10.1055/a-0820-2731

Hopkins RJ, Irvine T, Jamieson GG, Devitt PG, Watson DI. Long-term follow-up of two randomized trials comparing laparoscopic Nissen 360° with anterior 90° partial fundoplication. Br J Surg. 2020;107:56-63. https://doi.org/10.1002/bjs.11327

Gotley DC, Frankel AJ. Partial fundoplications (270° Toupet, 90° Dor). Foregut. 2021;1:182-4. https://doi.org/10.1177/26345161211021767

Håkanson BS, Lundell L, Bylund A, Thorell A. Comparison of laparoscopic 270° posterior partial fundoplication vs total fundoplication for the treatment of gastroesophageal reflux disease: a randomized clinical trial. JAMA Surg. 2019;154:479-86. https://doi.org/10.1001/jamasurg.2019.0047

Alimi YR, Esquivel MM, Hawn MT. Laparoscopic Heller myotomy and Toupet fundoplication. World J Surg. 2022;46:1535-41. https://doi.org/10.1007/s00268-022-06471-7

Siddaiah-Subramanya M, Yunus RM, Khan S, Memon B, Memon MA. Anterior Dor or posterior Toupet with Heller myotomy for achalasia cardia: A systematic review and meta-analysis. World J Surg. 2019;43:1563- 70. https://doi.org/10.1007/s00268-019-04945-9

Roque-González R, Martínez-Alfonso MÁ, JiménezRamos R, Anido-Escobar V, Morera-Pérez M. Calidad de vida y evolución clínica después de miotomía de Heller con fundoplicatura de Dor. Rev Cuba Cir. 2019;58:e784.

Sollie ZW, Jiwani AZ, Wei B. Robotic Heller myotomy. Mini-invasive Surg. 2020;4:80. https://doi.org/10.20517/2574-1225.2020.81

Allaix ME, Patti MG. Heller myotomy for achalasia. From the open to the laparoscopic approach. World J Surg. 2015;39:1603-7. https://doi.org/10.1007/s00268-014-2914-3

Vaezi MF, Pandolfino JE, Vela MF. ACG clinical guideline: Diagnosis and management of achalasia. Am J Gastroenterolog. 2013;108:1238-49. https://doi.org/10.1038/ajg.2013.196

Fontan AJA, Batista-Neto J, Pontes ACP, Nepomuceno M da C, Muritiba TG, Furtado R da S. Minimally invasive laparoscopic esophagectomy vs. transhiatal open esophagectomy in achalasia: A randomized study. Arq Bras Cir Dig. 2018;31:e1382. https://doi.org/10.1590/0102-672020180001e1382

Ou YH, Nie XM, Li LF, Wei ZJ, Jiang B. High-resolution manometric subtypes as a predictive factor for the treatment of achalasia: A meta-analysis and systematic review. J Dig Dis. 2016;17:222-35. https://doi.org/10.1111/1751-2980.12327

Kroch DA, Grimm IS. POEM for achalasia. Am Surg. 2018;84:489-95. https://doi.org/10.1177/000313481808400419

Dreifuss NH, Schlottmann F, Di Corpo M, Patti MG. Comparison of different treatment modalities and treatment algorithm for esophageal achalasia. In: Patti MG, Di Corpo M, Schlottmann F, editors. Foregut surgery. Copenhagen: Springer Cham; 2020. p. 91-102. https://doi.org/10.1007/978-3-030-27592-1_11

Schlottmann F, Patti MG. Esophageal achalasia: current diagnosis and treatment. Expert Rev Gastroenterolog Hepatol. 2018;12:711-21. https://doi.org/10.1080/17474124.2018.1481748

Patti MG, Fisichella PM. Controversies in management of achalasia. J Gastrointest Surg. 2014;18:1705-9. https://doi.org/10.1007/s11605-014-2556-7

Zaninotto G, Bennett C, Boeckxstaens G, Costantini M, Ferguson MK, Pandolfino JE, et al. The 2018 ISDE achalasia guidelines. Dis Esophagus. 2018;31 (9). https://doi.org/10.1093/dote/doy071

Sanagapalli S, McGuire J, Leong RW, Patel K, Raeburn A, Abdul-Razakq H, et al. The clinical relevance of manometric esophagogastric junction outflow obstruction can be determined using rapid drink challenge and solid swallows. Am J Gastronterol. 2021;116:280-8. https://doi.org/10.14309/ajg.0000000000000988

Van Hoeij FB, Ponds FA, Werner Y, Sternbach JM, Fockens P, Bastiaansen BA, et al. Management of recurrent symptoms after per-oral endoscopic myotomy in achalasia. Gastrointest Endosc. 2018;87:95-101. http://dx.doi.org/10.1016/j.gie.2017.04.036

Patti MG, Allaix ME. Recurrent symptoms after Heller myotomy for achalasia: Evaluation and treatment. World J Surg. 2015;39:1625-30. https://doi.org/10.1007/s00268-014-2901-8

Schlottmann F, Andolfi C, Kavitt RT, Konda VJA, Patti MG. Multidisciplinary approach to esophageal achalasia: A single center experience. J Laparoendoscop Adv Sur Tech. 2017;27:358-62. https://doi.org/10.1089/lap.2016.0594

Milito P, Siboni S, Lovece A, Andreatta E, Asti E, Bonavina L. Revisional therapy for recurrent symptoms after Heller myotomy for achalasia. J Gastrointest Surg. 2022;26:64-9. https://doi.org/10.1007/s11605-021-05098-8

Kilic A, Schuchert MJ, Pennathur A, Gilbert S, Landreneau RJ, Luketich JD. Long-term outcomes of laparoscopic Heller myotomy for achalasia. Surgery. 2009;146:826-33. http://dx.doi.org/10.1016/j.surg.2009.06.049

Perry KA, Kanji A, Drosdeck JM, Linn JG, Chan A, Muscarella P, et al. Efficacy and durability of robotic Heller myotomy for achalasia: patient symptoms and satisfaction at long-term follow-up. Surg Endoscop. 2014;28:3162-7. https://doi.org/10.1007/s00464-014-3576-9

Jeansonne LO, White BC, Pilger KE, Shane MD, Zagorski S, Davis SS, et al. Ten-year follow-up of laparoscopic Heller myotomy for achalasia shows durability. Surg Endosc. 2007;21:1498-502. https://doi.org/10.1007/s00464-007-9500-9

Zhang WG, Chai NL, Zhai YQ, Linghu EQ, Li HK. Longterm outcomes of peroral endoscopic myotomy in achalasia patients with a minimum follow-up of 7 years. Chin Med J. 2020;133:996-8. https://doi.org/10.1097/CM9.0000000000000735

Ramchandani M, Nageshwar Reddy D, Nabi Z, Chavan R, Bapaye A, Bhatia S, et al. Management of achalasia cardia: Expert consensus statements. J Gastroenterol Hepatol. 2018;33:1436-44. https://doi.org/10.1111/jgh.14097

Hulselmans M, Vanuytsel T, Degreef T, Sifrim D, Coosemans W, Lerut T, et al. Long-term outcome of pneumatic dilation in the treatment of achalasia. Clin Gastroenterol Hepatol. 2010;8:30-5. http://dx.doi.org/10.1016/j.cgh.2009.09.020

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2023-04-01

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Forero-Vásquez, B. N.; Yopasa-Romero, J. J. Diagnóstico Y Manejo Actual De La Acalasia. Rev Colomb Cir 2023, 38, 330-338.

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