Achalasia is a rare oesophageal disease characterised by an unrelaxing lower oesophageal sphincter and abnormal peristalsis of the oesophageal body. Achalasia symptoms include dysphagia to solid and liquid, chest pain, regurgitation and weight loss. Achalasia diagnosis might be delayed for many years when atypical symptoms dominate. Significant progress has been made over the last two decades regarding our understanding of pathophysiology, methods of evaluation and management. The development of high-resolution manometry in particular has improved the diagnosis of achalasia, as well as other major motility disorders. Subtyping achalasia into manometric patterns has pathophysiological and therapeutic implications. Furthermore, complementary tests such as timed barium swallow and the functional lumen imaging probe (EndoFLIP; Crospon Medical Devices, Galway, Ireland) have significantly added to achalasia diagnosis algorithm and management decision-making. Progression in management has helped optimise established therapy (pneumatic dilatation and Heller myotomy) and introduced new endoscopic treatments (peroral endoscopic myotomy) and surgical techniques (surgical robotic Heller myotomy). This review will aim to shed light on the most recent advances in achalasia diagnosis, classification and management.

中文翻译：

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贲门失弛缓症：超越基础


贲门失弛缓症是一种罕见的食管疾病，其特征是食管下括约肌不松弛和食管体蠕动异常。贲门失弛缓症的症状包括固体和液体吞咽困难、胸痛、反流和体重减轻。当非典型症状占主导地位时，贲门失弛缓症的诊断可能会延迟很多年。在过去的二十年里，我们在对病理生理学、评估和管理方法的理解方面取得了重大进展。特别是高分辨率测压法的发展改善了贲门失弛缓症以及其他主要动力障碍的诊断。将贲门失弛缓症亚型为测压模式具有病理生理学和治疗意义。此外，补充测试，如定时吞钡和功能管腔成像探头 （EndoFLIP;Crospon Medical Devices， Galway， Ireland） 显着增加了贲门失弛缓症诊断算法和管理决策。管理的进展有助于优化既定疗法（球囊扩张术和 Heller 肌切开术），并引入新的内窥镜治疗（经口内窥镜肌切开术）和手术技术（手术机器人 Heller 肌切开术）。本综述旨在阐明贲门失弛缓症诊断、分类和管理的最新进展。