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Direct-Acting Cholinergic Agonists: Therapeutic Uses01:11

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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...
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Direct-Acting Cholinergic Agonists: Pharmacokinetics01:31

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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...
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Direct-Acting Cholinergic Agonists: Pharmacological Actions00:59

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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...
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Skeletal Muscle Relaxants: Therapeutic Uses01:31

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Skeletal muscle relaxants are used to relax muscle tone and alleviate painful muscle contractions. However, the choice of skeletal muscle relaxants depends on the duration of the surgical procedure in order to minimize potential side effects. Skeletal muscle relaxants like neuromuscular blocking agents [NMBAs] are commonly employed as adjuvants alongside general anesthetics in clinical settings. NMBAs are also used to maintain controlled ventilation during surgery of the larynx or pharynx...
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Peptic Ulcer Disease IV: Management01:26

Peptic Ulcer Disease IV: Management

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Medical treatment strategies for peptic ulcers encompass various methods. The primary goal of treatment is to diminish gastric acidity and strengthen mucosal defense mechanisms.
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Pharmacological management
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Indirect-Acting Cholinergic Agonists: Pharmacological Actions01:30

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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.
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Updated: Aug 27, 2025

Robotic Myotomy and Partial Fundoplication for Achalasia
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Achalasia: Current therapeutic options.

Sebastien Rolland1, William Paterson2, Robert Bechara2

  • 1Division of Gastroenterology, Hôpital Maisonneuve-Rosemont and Université de Montreal, Montreal, Quebec, Canada.

Neurogastroenterology and Motility
|September 25, 2022
PubMed
Summary
This summary is machine-generated.

Achalasia treatment options like pneumatic dilation, laparoscopic Heller myotomy, and peroral endoscopic myotomy offer effective symptom relief. These established therapies provide safe and marked improvement for patients with this esophageal motor disorder.

Keywords:
achalasiabotulinum toxinlaparoscopic Heller myotomyperoral endoscopic myotomypneumatic dilation

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Area of Science:

  • Gastroenterology
  • Gastrointestinal Motility Disorders
  • Esophageal Diseases

Background:

  • Achalasia is a rare esophageal motor disorder characterized by impaired lower esophageal sphincter relaxation and absent esophageal peristalsis.
  • Symptoms include dysphagia, regurgitation, chest pain, and weight loss, significantly impacting patient quality of life.

Purpose of the Study:

  • To review current, evidence-based therapeutic options for achalasia.
  • To compare the efficacy, risks, and recurrence rates of established achalasia treatments.
  • To highlight recent advancements in achalasia management.

Main Methods:

  • Comprehensive literature review of therapeutic modalities for achalasia.
  • Analysis of comparative controlled clinical trials.
  • Inclusion of technical procedural details for key treatments.

Main Results:

  • Pneumatic dilation (PD), laparoscopic Heller myotomy (LHM), and peroral endoscopic myotomy (POEM) are safe and effective treatments for achalasia.
  • These interventions lead to significant symptom improvement in most patients.
  • Botulinum toxin offers temporary relief but requires repeat injections with diminishing efficacy.

Conclusions:

  • PD, LHM, and POEM are well-established, effective therapies for achalasia, each with unique risk-benefit profiles.
  • Treatment selection depends on patient preference, achalasia subtype, and local expertise.
  • Significant progress has been made in achalasia treatment, with ongoing advancements in procedural techniques.