Primary Motility  Disorders of the  Esophagus
 The Esophageal
 Esophagogastric  Junction

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Volume: The Esophagogastric Junction
Chapter: Achalasia

Should LES dysfunction be considered as the primary defect?
E.P. Eypasch (Cologne) 

What is the frequency of the progression of DES towards achalasia?
S. Bruley des Varannes, J.P. Galmiche (Nantes), C. Scarpignato (Parma) 

What is the aspect of ganglion cells in the proximal stomach, that is, are the ganglion cells in the cardia in achalasia normal or not?
H.D. Appelman (Ann Arbor) 

Does degeneration of the myenteric plexuses involve the extrinsic nerves of the esophagus?
J. Bancewicz (Salford) 

Are endoscopic biopsies likely to give any useful information in achalasia?
J.R. Goldblum (Cleveland) 

What can be expected from immunohistochemistry in detecting factors responsible for degeneration of myenteric neurons in achalasia?
C. Singaram (Madison) 

Can antibodies reacting with Auerbach's plexuses be demonstrated in achalasia?
W.B. Storch (Heidelberg) 

Should the finding of an antibody against neurons represent an argument for a possible causative factor?
C. Singaram (Madison) 

What are the pathologic features of achalasia taken from esophagectomy specimens in patients with early achalasia?
J.R. Goldblum (Cleveland) 

What specific extra-myenteric histologic features are related to obstruction and stasis in patients with achalasia?
J.R. Goldblum (Cleveland) 

Is synthesis of nitric oxide altered in gastroesophageal junction?
S. Bruley des Varannes, J.P. Galmiche (Nantes), C. Scarpignato (Parma) 

What is the evidence for a viral cause of achalasia?
R.O. Dantas (Rebeirão Preto) 

Is idiopathic achalasia related to genetic markers?
A. Troukhmanov (Moscow) 

What is the histologic natural history of achalasia?
H.D. Appelman (Ann Arbor) 

Functional features

What is the functional value of LES relaxation that can be observed in achalasia?
D. Sifrim, J. Janssens, J. Tack (Leuven) 

Using prolonged motor activity monitoring, what is the proportion of peristaltic esophageal contractions occurring in patients with achalasia?
R.M. Bremner, M. Costantini, T.R. DeMeester (Los Angeles) 

What is the correlation between LES pressure and esophageal emptying?
R.K.H. Wong (Washington) 

What is the rate of GER-related heartburn in patients with achalasia?
P.F. Crookes (Los Angeles) 

What are the features of esophageal dysmotility in children?
J.A. Tovar, G. Prieto, M. Molina, J. Arana (Madrid) 

What is the relationship between pressure or length of the upper esophageal sphincter and aspiration pneumonia?
A. Lambroza (New York) 

Achalasia as part of the Allgrove syndrome
J. Pérez de la Serna, A. Ruiz de León, C. Sevilla-Mantilla, M. Díaz-Rubio (Madrid) 

Pseudo or secondary achalasia

What is pseudoachalasia, what are its causes?
P.J. Kahrilas (Chicago) 

What are the radiographic appearances of secondary achalasia, and how can it be differentiated from primary achalasia in barium studies?
E.M. Smith (Norfolk), T.K. Chaudhuri (Hampton) 

Pseudo or secondary achalasia: can manometric findings differentiate between? Are there specific criteria to distinguish achalasia from underlying malignancy?
R.C. Orlando (New Orleans) 

Can esophageal pharmacomanometry be of clinical use?
T.R. Weihrauch (Wuppertal) 

Is there an explanation for the frequent mid third localization of esophageal carcinomas occurring in patients with achalasia?
R.K.H. Wong (Washington) 

Medical treatments

Is the effect of peripheral opioid agonists (loperamide) on resting LES pressure to be considered in combination with other drugs in achalasia?
R. Penagini (Milan) 

What are the indications for treatment of achalasia with pharmacologic agents?
M. Bortolotti (Bologna) 

What should be expected from endoscopic injection of botulinum toxin into the LES?
P.J. Pasricha (Gavelstone) 

Is there a place for direct endo-electrostimulation in the treatment of achalasia?
A. Troukhmanov (Moscow) 


What are the best markers of the degree of functional obstruction?
K. Bielefeldt (Iowa City) 

What objective variables are to be considered or predictive of symptomatic response to pneumatic dilatations? LES pressure, esophageal emptying? Resistance at the level of the EG junction?
R.K.H. Wong (Washington) 

What is the value of the radiological diameter of the EG junction following dilatation?
D.J. Ott, M.Y.M.Chen (Winston-Salem) 

Is a normal relaxation of the LES a predictive factor of response to pneumatic dilatations?
V. Garrigues, J. Ponce, C. Gálvez, V. Pons (Valencia) 

What is the value of the new controlled radial-expansion variable balloon for dilatation in achalasia?
J.S. Barkin, L. Hurwitz (Miami) 

Is the Witzel dilator under endoscopic vision safer than other dilators?
T.T. Nostrant (Ann Arbor) 

Are there indications for self-expanding stents in achalasia?
R. Lillo-Gil, W. Cwikiel (Lund) 

Are there indications for pneumatic dilatation in young patients?
Should the age of the patient be predictive of non-effective dilatation?

E.H. Metman, L. d'Alteroche, L. Picon (Tours) 

What are the compared effects of dilatation on clinical symptoms, esophageal motility and esophageal diameter?
J.J. Hsu (Rochester, NY) 

Is there a relationship between the size of the dilator, the duration of inflation, the frequency of inflation, and objective changes in esophageal motor function?
J.J. Hsu (Rochester, NY) 

What are the factors that affect the outcome of pneumatic dilatation?
R.K.H. Wong (Washington) 

What is the value of endosonography in assessing the result of pneumatic dilatation?
H. van Overhagen, M.L. Hordijk, G.L. Ong (Rotterdam)  

How can the frequent lack of correlation between clinical improvement and objective measurements be explained?
E.H. Metman, L. Picon, L. d'Alteroche (Tours) 

Are symptoms correlated to pH-metry findings after dilatation?
J. Pérez de la Serna, A. Ruiz de León, C. Sevilla Mantilla, M. Díaz-Rubio (Madrid) 

When is the best time to perform pH-metry after dilatation?
J. Pérez de la Serna, A. Ruiz de León, C. Sevilla Mantilla, M. Díaz-Rubio (Madrid) 

What is the status of gastric emptying after successful dilatation?
L. Benini, C. Sembenini, I. Vantini (Verona) 

What is the rate of GER after pneumatic dilatation?
C.A. Pellegrini, A. Porter (Seattle), M.G. Patti (San Francisco) 

What are the greatest factors of risk of esophageal perforation in pneumatic dilatation for achalasia? Is the presence of an epiphrenic diverticulum a contraindication to dilatation?
D. Couturier, M. Gaudric (Paris) 

Does a myotomy contraindicate subsequent dilatations?
J. Janssens, J. Tack, D. Sifrim (Leuven) 

Conventional myotomy - Endoscopic myotomy

What precisions concerning the site and length of myotomy could be expected from the present knowledge on the muscular structure of the LES?
D. Liebermann-Meffert, H.J. Stein (Munich) 

What can be expected from new methods of intra-operative manometry to limit the length of associated myectomy? What are its specific indications?
P. Kohek, P. Rehak, G. Glanzer, G.B. Friehs (Graz) 

Is distal extension of myotomy linked with subsequent reflux?
P.E. Donahue (Chicago) 

Should myotomy be extended in "vigorous achalasia"?
L.F. Martinez de Haro, P. Parrilla, A. Ortiz (Murcia) 

Are there specific indications for adding an AR procedure to the myotomy?
A.L. DePaula (Goiana) 

Which AR procedure should be used?
A. Watson (London) 

Are there specific indications for thoracoscopic or laparoscopic myotomy for achalasia?
C.A. Pellegrini, A. Porter (Seattle), M.G. Patti (San Francisco) 

What is the rate of abnormal reflux following thoracoscopic approach?

What are the effects of thoracoscopic myotomy on LES vector volume, compared to open myotomy?
J.H. Peters, P.F. Crookes, T.R. DeMeester (Los Angeles) 

Common problems

What is the nature of the LESP modifications induced by myotomy?
A. Del Genio, G. Izzo, N. Di Martino, V. Maffettone, P. Zampiello, A. Martella, P. Mugione, A. Renzi (Naples) 

Are variations of resting LESP after esophageal and gastric myotomy precisely known?
G.G. Jamieson (Adelaide) 

Compared to open myotomy, what is the rate of abnormal 24-hour acid exposure after endoscopic approach?
J. Heimbucher, K.H. Fuchs, S.M. Freys, A. Thiede (Würzburg) 

Should low esophageal pH after myotomy be unequivocally interpreted as GER?
P.F. Crookes (Los Angeles) 

When fundoplication is added to the myotomy, is there a risk of intra-thoracic migration of the valve after reduction of the esophageal caliber?
I. Cecconello, R.A. Sallum, B. Zilberstein, H.W. Pinotti (Sao Paulo)  

What is the effect of myectomy on the pressure profile of the LES?
N. Di Martino, G. Izzo (Naples), C.W.P. Van Der Hoeven (Amsterdam) 

What are the factors involved in the return of peristalsis after surgical myotomy?
L.F. Martínez de Haro, P. Parrilla, A. Ortiz (Murcia) 

What are the comparative long-term results of medical treatment, dilatation, open and minimally invasive surgery in the treatment of achalasia?
M.G. Patti, M. Arcerito, L.W. Way (San Francisco) 

What are the late results of myotomy in children?
N.A. Myers, R. Taylor (Victoria), S.G. Jolley (Las Vegas) 

What is the rate of late strictures following myotomy?

What are their causes?
C.A. Pellegrini, A. Porter (Seattle), M.G. Patti (San Francisco) 

Are the results of myotomy altered by previous dilatations?
J.C. Chiocca, G.B. Salis (Buenos Aires) 
A. Csendes (Santiago) 

Publication date: May 1998 OESO©2015