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Nat Rev Gastroenterol Hepatol. 2015 Jun;12(6):332-41. doi: 10.1038/nrgastro.2015.45. Epub 2015 Mar 31.

Therapeutic options in oesophageal dysphagia.

Author information

1
Translational Research Center for Gastrointestinal Disorders, KU Leuven, Herestraat 49, 3000 Leuven, Belgium.
2
Imperial College, Department of Surgery and Cancer, St Mary's Hospital, Praed Street, Paddington, London W2 1NY, UK.

Abstract

High-resolution manometry enables the categorization of patients with oesophageal dysphagia caused by oesophageal motility disorders into diagnostic categories according to the Chicago Classification. This Review provides an overview of the literature concerning treatment options for patients with dysphagia associated with achalasia, hypercontractile disorders and hypocontractility disorders of the oesophagus. In achalasia, pharmacotherapy and botulinum toxin are less effective than pneumatic dilation or surgical Heller myotomy, which had comparable efficacy in the largest controlled trial to date. Peroral endoscopic myotomy is a novel therapeutic modality that is currently being evaluated in controlled trials versus pneumatic dilation or surgical myotomy. A variety of medical treatments have been evaluated in hypermotility disorders, but only botulinum toxin injection yielded favourable results in a single controlled trial. Few studies have addressed the treatment of dysphagia in patients with oesophageal hypomotility. A variety of prokinetic agents have been studied, but there is no evidence of clinically relevant efficacy from controlled trials.

PMID:
25824996
DOI:
10.1038/nrgastro.2015.45
[Indexed for MEDLINE]

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