Related Experiment Video
Updated: Aug 5, 2026
06:42
Use of the Scissor-Type Knife During the Peroral Endoscopy Myotomy Procedure for the Treatment of Achalasia
Published on: March 3, 2023
Pharmacologic therapy in treating achalasia
1Division of Gastroenterology and Hepatology, University of Texas Medical Branch, Galveston, Texas 77555-0764, USA.
Gastrointestinal Endoscopy Clinics of North America
|April 25, 2001
Summary
This review discusses achalasia pharmacologic treatments. While nitrates and calcium channel blockers offer temporary relief, botulinum toxin provides effective, longer-lasting results for many patients, especially the elderly.
Area of Science:
- Gastroenterology
- Pharmacology
Background:
- Achalasia is a rare esophageal motility disorder characterized by impaired relaxation of the lower esophageal sphincter and loss of peristalsis.
- Current management options include pneumatic dilation, surgical myotomy, and pharmacologic therapies.
Purpose of the Study:
- To review and discuss the various pharmacologic treatments available for achalasia.
- To evaluate the efficacy, mechanism of action, and suitability of different drug classes for achalasia management.
Main Methods:
- Review of existing literature on pharmacologic treatments for achalasia.
- Analysis of drug mechanisms, clinical efficacy, and patient-specific considerations.
Main Results:
- Nitrates and calcium channel blockers provide only temporary symptom relief in achalasia patients.
- Botulinum toxin demonstrates efficacy in approximately two-thirds of patients, with effects lasting several months.
- Botulinum toxin is a viable option for elderly or high-risk achalasia patients.
Conclusions:
- Pharmacologic treatments for achalasia offer varying degrees of efficacy and duration.
- Botulinum toxin represents a significant therapeutic option, particularly for specific patient populations.
- Further research into optimizing pharmacologic strategies for achalasia is warranted.
Related Concept Videos
01:31Direct-Acting Cholinergic Agonists: Pharmacokinetics
Direct-acting cholinergic agonists, such as synthetic choline esters and naturally occurring alkaloids, exert their effects by enhancing the actions of acetylcholine and stimulating the parasympathetic nervous system. Synthetic choline esters share structural similarities with acetylcholine. For example, they have a positively charged quaternary ammonium or onium group, contributing to their hydrophilic characteristics. As a result, they are poorly absorbed in the body through oral...
00:59Direct-Acting Cholinergic Agonists: Pharmacological Actions
Direct-acting cholinergic agonists exert their pharmacological actions by mimicking the effects of acetylcholine on postsynaptic muscarinic receptors to generate parasympathetic responses. These agents elicit a range of physiological responses, including cardiovascular effects. For example, activation of muscarinic receptors induces bradycardia, decreased cardiac output, reduced peripheral resistance, and consequent hypotension. In the eye, stimulation of M3 receptors leads to smooth muscle...
01:11Direct-Acting Cholinergic Agonists: Therapeutic Uses
Direct-acting cholinergic agonists have many therapeutic uses in various medical fields. Choline esters, including acetylcholine, have limited clinical utility due to their non-selectivity and short duration of action. Still, acetylcholine and carbachol are applied topically during ophthalmologic surgery to induce miosis. Pilocarpine, a muscarinic and ganglionic stimulator, effectively treats open-angle glaucoma and alleviates xerostomia and dry mouth caused by radiotherapy or Sjögren syndrome.
01:30Indirect-Acting Cholinergic Agonists: Pharmacological Actions
Indirect-acting cholinergic agonists, also known as anticholinesterases, exert their pharmacological effects by enhancing cholinergic transmission in various body parts, including the neuromuscular junction, autonomic cholinergic synapses, and the brain.
At the neuromuscular junction, these agents work by inhibiting the breakdown of acetylcholine, allowing it to remain bound to the receptor and bind to nearby receptors. This process leads to repetitive firing of the endplate, causing muscle...
At the neuromuscular junction, these agents work by inhibiting the breakdown of acetylcholine, allowing it to remain bound to the receptor and bind to nearby receptors. This process leads to repetitive firing of the endplate, causing muscle...
01:26Peptic Ulcer Disease IV: Management
Medical treatment strategies for peptic ulcers encompass various methods. The primary goal of treatment is to diminish gastric acidity and strengthen mucosal defense mechanisms.
The therapeutic approach involves ensuring adequate rest, implementing drug therapy, promoting smoking cessation, making dietary modifications, and emphasizing long-term follow-up care.
Pharmacological management
The prevailing therapy for peptic ulcers involves a combination of managing the patient's current medication...
The therapeutic approach involves ensuring adequate rest, implementing drug therapy, promoting smoking cessation, making dietary modifications, and emphasizing long-term follow-up care.
Pharmacological management
The prevailing therapy for peptic ulcers involves a combination of managing the patient's current medication...
01:27Esophageal Achalasia
Esophageal achalasia is a chronic neurogenic disorder characterized by impaired relaxation of the lower esophageal sphincter (LES) and absent or ineffective peristalsis in the distal esophagus. This leads to a functional obstruction without a physical blockage, despite significant disruption of esophageal motility.EtiologyAchalasia is caused by degeneration of the myenteric (Auerbach's) plexus, specifically the loss of inhibitory ganglion cells that produce vasoactive intestinal peptide (VIP)...