Background Though nitrates have been used in achalasia for a long time, the effectiveness of nitrates for achalasia is still controversial. Objectives To quantify short-term and long-term effects of nitrate therapy in patients with achalasia. Search strategy Trials were identified by searching the Cochrane Controlled Trials Register (Issue 4, 2001), MEDLINE (1966-2001), EMBASE (1980-2001), LILACS-Latin American and Caribbean health science literature (1982-2001) and CBM-Chinese Biomedical Database (1980-2000). Additionally, all references in the identified trials were checked for further relevant trials. Selection criteria All randomised controlled trials involving achalasia patients given any type of nitrates were included. Data collection amp; analysis Data were extracted By two independent observers based on the intention-to-treat principle. Odds ratios for the patients need to treat by invasive procedures, improvement of symptoms, LES pressure decrease, oesophageal emptying, and side effects were calculated. Numbers needed to treat (NNT) for avoiding invasive procedure, improvement of symptoms, oesophageal emptying, and numbers needed to harm (NNH) of side effects were also determined. Main results Two randomised cross-over studies were found, But no results are included. Due to the design of the studies and the method of reporting the results in the original paper it was not possible to extract the necessary information to examine any of the outcomes. Authors have been contacted to obtain this information. Reviewers’ conclusion We can conclude no implications for practice at this stage. Much more RCT data are needed to determine the effects of nitrates.
Objective To investigate the feasibility and safety of laparoscopic operation of gastric and gastroesophageal junction diseases. Methods Between May 2004 and June 2009, 59 patients with gastric and gastroesophageal diseases were treated laparoscopically. The operative methods and maneuvers were evaluated and perioperative interventions, complications and efficacy of patients were analyzed. Results All operations were successfully completed laparoscopically except for one patient with gastric cancer who required a conversion to open surgery. No short-term complications occurred in all cases. No port transplant metastasis occurred for the patients with gastric cancer after an average of 36 months (1-60 months) follow-up. One patient died of liver metastasis 12 months after operation. The 3-year survival rate was 93.3% (14/15). Conclusion Laparoscopic surgery of the gastric and gastroesophageal junction diseases is feasible and safe with minimal invasiveness, which is worth popularizing.
ObjectiveTo understand research progress of animal model of esophageal achalasia and discuss its pathogenesis briefly.Method Literatures about research progress of animal model of esophageal achalasia were reviewed. ResultsThe models of esophageal achalasia could been made in several ways, such as the obstruction model, the classic denervation model, and the increasingly popular gene model. These models were all based on the theory of the corresponding causes, with the processing of different factors, then completed the preparation of animal model. Conclusionsanimal model of esophageal achalasia goes through three stages: obstruction model, denervation model, and gene model. gene model of esophageal achalasia based on congenital theory could help us understand this disease better and make an ideal animal model, which could provide a reliable evidence for etiology study.
Objective To review the clinical experience of Heller myotomy for treatment of achalasia through a small thoracotomy. Methods Twenty-five patients with achalasia (9 moderate, 16 severe) underwent Heller myotomy without concomitant antireflux procedure through a small incision. A left thoracotomy was carried out through either the seventh or eighth intercostals space. The length of skin incision was 6 to 8 cm. Results There was no hospital death and severe postoperative complications. The mean operating time was 50 minutes. Mean hospital stay was 10 days. There was one intraoperative perforation and repaired successfully. All patients reported good to excellent relief of dysphagia and no symptom of gastroesophageal reflux after surgery. Eight patients were subsequently studied with a 24-hour esophageal pH monitoring and no evidence of pathologic reflux found. Conclusions Transthoracic Heller myotomy with a small incision is effective and safe method for treatment of achalasia with minimal invasion, quick recovery, less postoperative complication and shorter hospital stay. Proper extent of the myotomy may decrease the risk of subsequent gastroesophageal reflux in the postoperative period.
Objective Through a retrospective study on esophageal function changes and symptom relief after video-assisted thoracoscopic surgery treatment for achalasia of cardia (AC) to assess the clinical value of this operation. Methods We reviewed the data of 34 AC patients who received modified Heller operation by video-assisted thoracoscopic surgery in the Affiliated Hospital of Guizhou Medical University from March 2012 to September 2014. There were 11 males and 23 females with a median age of 35 (11–67) years. These patients were divided into four groups according to the time of treatment and follow-up: preoperative group, postoperative one-month group, postoperative three-month group and postoperative six-month group. Changes of symptoms, radiography and esophageal dynamics before and after therapy were collected. These different groups were analyzed based on statistical methods. Results There was no statistical difference in ages and genders among groups (P>0.05). The surgery was successful and no complication or death occurred. Symptoms of patients showed different degrees of relief and the postoperative grade of clinical symptoms decreased (P<0.05). After surgery, lower esophageal sphincter pressure (LESP), lower esophageal sphincter resting pressure (LESRP) and esophageal body pressure (EBP) decreased significantly, while lower esophageal sphincter relax rate (LESRR) increased (P<0.05). While there was no significant difference in length of lower esophageal sphincter (LESL,P>0.05). Angiography of upper digestive tract revealed that compared to the preoperative group, the maximum width in postoperative three-month group decreased significantly (P<0.05). During the follow-up, 3 patients suffered gastroesophageal reflux, 2 patients esophageal perforation and 1 patient empyema due to esophago-pleural fistula. No massive hemorrhage of upper digestive tract and hiatal hernia occured. Conclusion Sugery can significantly ameliorate the clinical symptoms of the patients with AC, and improve esophageal dynamics. And it is simple and easy to perform with less complications and better long-term outcomes. Improved Heller operation by video-assisted thoracoscopy is a less invasive procedure when compared with the traditional thoracotomy. Moreover, esophageal manometry can objectively assist in the diagnosis and degree of the disease and effect of therapy.
Objective Through the methods of evidence-based medicine, to make an individualized treatment plan for a patient with achalasia. Methods Based on an adequate assessment of the patient’s condition, clinical issues aimed at this case were put forward. And the best clinical evidence related to achalasia treatment was evaluated after being retrieved from The Cochrane library (1990 to 2010) and PubMed (1980 to 2010). Results 33 studies were retrieved including 29 RCTs and 4 systematic reviews. The efficacy and safety of drug therapy, endoscopic injection of botulinum, endoscopic balloon dilatation and surgical therapy were evaluated. Cosidering symptoms,age and comorbidities, we recommended endoscopic balloon dilatation or laparoscopic Heller postoperative plus Dor fundoplication surgery for treatment. The patient’s choice is endoscopic balloon dilatation. Symptoms of patient were relieved after treatment. Conclusion Making a rational therapeutic plan for achalasia patients by means of evidence-based treatment not only can improve therapeutic effect but also be beneficial for both doctors and patients to share uncertain risks.