Abstract
Achalasia is not uncommonly diagnosed in elderly patients and its incidence and prevalence are growing in this population. However, a scarcity of studies has assessed the typical pathophysiological and clinical features of the disease as well as the effectiveness and safety of the various therapeutic options in elderly populations. Botulinum toxin injection has been used for achalasia treatment since 1994 and is traditionally considered the preferred treatment for fragile elder patients. However, recently more evidence has become available regarding the safety and effectiveness of pneumatic balloon dilation (BD), laparoscopic Heller myotomy (LHM) and per-oral endoscopic myotomy (POEM) in elderly patients with achalasia. In the current review we present the current literature on this topic with a focus on the clinical presentation of achalasia in the elderly and manometric features thereof, as well as summarize the effectiveness and safety of the various therapeutic options. Furthermore, we propose a practical management algorithm as a means to guide the treatment of future cases. We recommend that a conservative/BTI approach should be adopted in the fragile unfit patient. In the elderly fit patient, the treatment decision should be based on the achalasia type, patient preference and the available expertise, similar to the approach adopted for the non-elderly population.
Highlights
Research findings propose a theory of an autoimmune reaction activated by a viral infection, leading to a cascade of a destructive inflammatory process resulting in destruction of the nitric oxide-releasing neurons within the myenteric plexus [1]
A study by Schechter et al that aimed to investigate clinical and manometric findings in older patients compared with younger patients has revealed that elder achalasia patients are less symptomatic and have lower pressure of the lower esophageal sphincter (26.4 mm Hg vs. 31.9 mm Hg, p = 0.001) [10]
In the current review we aim to provide an updated comprehensive review on the assessment and management of achalasia in elderly patients
Summary
Amir Mari 1,2 , Wisam Sbeit 2,3 , Wisam Abboud 2,4 , Halim Awadie 5 and Tawfik Khoury 2,3, *.
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