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World J Clin Cases. Mar 16, 2023; 11(8): 1741-1752
Published online Mar 16, 2023. doi: 10.12998/wjcc.v11.i8.1741
Pathogenesis, clinical manifestations, diagnosis, and treatment progress of achalasia of cardia
Ming-Yue Li, Qing-Hua Wang, Run-Peng Chen, Xiao-Fang Su, Dong-Yang Wang
Ming-Yue Li, Qing-Hua Wang, Run-Peng Chen, Xiao-Fang Su, Dong-Yang Wang, School of Nursing, Binzhou Medical University, Yantai 264003, Shandong Province, China
Dong-Yang Wang, Faculty of Nursing, Mahidol University, Nakhon Pathom 73170, Thailand
Author contributions: Li MY and Wang QH contribute equally to this work; Li MY, Wang QY, and Wang DY performed the majority of the writing, prepared the figures and tables; Chen RP performed data accusation and writing; Su XF provided the input in writing the paper; Wang QH and Wang DY designed the outline and coordinated the writing of the paper.
Conflict-of-interest statement: The authors declared that no conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Dong-Yang Wang, PhD, RN, Lecturer, Nurse, Researcher, School of Nursing, Binzhou Medical University, No. 346 Guanhai Road, Yantai 264003, Shandong Province, China. wangdongyang1994@gmail.com
Received: January 11, 2023
Peer-review started: January 11, 2023
First decision: February 2, 2023
Revised: February 6, 2023
Accepted: February 21, 2023
Article in press: February 21, 2023
Published online: March 16, 2023
Processing time: 54 Days and 20.6 Hours
Abstract

Achalasia cardia, type of esophageal dynamic disorder, is a relatively rare primary motor esophageal disease characterized by the functional loss of plexus ganglion cells in the distal esophagus and lower esophageal sphincter. Loss of function of the distal and lower esophageal sphincter ganglion cells is the main cause of achalasia cardia, and is more likely to occur in the elderly. Histological changes in the esophageal mucosa are considered pathogenic; however, studies have found that inflammation and genetic changes at the molecular level may also cause achalasia cardia, resulting in dysphagia, reflux, aspiration, retrosternal pain, and weight loss. Currently, the treatment options for achalasia focus on reducing the resting pressure of the lower esophageal sphincter, helping to empty the esophagus and relieve symptoms. Treatment measures include botulinum toxin injection, inflatable dilation, stent insertion, and surgical myotomy (open or laparoscopic). Surgical procedures are often subject to controversy owing to concerns about safety and effectiveness, particularly in older patients. Herein, we review clinical epidemiological and experimental data to determine the prevalence, pathogenesis, clinical presentation, diagnostic criteria, and treatment options for achalasia to support its clinical management.

Keywords: Achalasia cardia; Pathogenesis; Clinical manifestations; Diagnosis; Treatment

Core Tip: Achalasia is a relatively rare primary motility esophageal disorder characterized by loss of function of the plexus ganglion cells of the distal esophagus and the lower esophageal sphincter. Histological changes in the esophageal mucosa are considered pathogenic; however, studies have found that inflammation and genetic changes at the molecular level may also cause achalasia cardia, resulting in dysphagia, reflux, aspiration, retrosternal pain, and weight loss. This review article aims to conduct a comprehensive literature review and present current knowledge about achalasia.