The 2018 ISDE achalasia guidelines

Area of Science:

• Gastroenterology
• Esophageal Motility Disorders

Background:

• Achalasia is a rare primary esophageal motor disorder causing dysphagia and regurgitation.
• New diagnostic and therapeutic options necessitate updated management strategies.

Purpose of the Study:

• To present the International Society for Diseases of the Esophagus Guidelines (I-GOAL) for achalasia management.
• To provide clinicians and patients with an up-to-date framework for informed decision-making.

Main Methods:

• Guidelines developed using the AGREE-REX tool and GRADE methodology.
• Systematic literature search, expert consensus (DELPHI process with >80% approval).
• Involved 51 international experts and 3 patient representatives.

Main Results:

• Guidelines cover diagnosis, disease definition, severity, and various treatments (medical, botulinum toxin, pneumatic dilatation, POEM, myotomy).
• Addresses recurrence, follow-up, cancer risk, end-stage disease, treatment failure, pediatric achalasia, and Chagas-related achalasia.
• Recommendations based on integrated evidence grading and expert consensus.

Conclusions:

• The I-GOAL guidelines provide a robust, evidence-based, and consensus-driven approach to achalasia management.
• Aims to standardize care and improve outcomes for patients with this rare disorder.