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La acalasia: una revisión sistemática

John E Pandolfino¹, Andrew J Gawron²

¹Division of Gastroenterology and Hepatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.

|May 13, 2015

Resumen

El diagnóstico de la acalasia requiere considerar la disfagia y el reflujo refractario cuando se descarta la obstrucción. El éxito del tratamiento para este trastorno de la motilidad esofágica varía según el subtipo, lo que afecta los resultados del paciente.

Área de la Ciencia:

Gastroenterología y Gastroenterología.
Trastornos de movilidad esofágica Trastornos de movilidad esofágica.
Intervenciones quirúrgicas y endoscópicas.

Sus antecedentes:

La acalasia es un trastorno de la motilidad esofágica que afecta significativamente la calidad de vida del paciente.
El diagnóstico y el tratamiento de la acalasia puede ser un desafío para los médicos.

Objetivo del estudio:

Revisar el diagnóstico y el manejo de la acalasia.
Centrarse en la clasificación fenotípica y su relación con los resultados terapéuticos.

Principales métodos:

Se llevó a cabo una revisión exhaustiva de la literatura y una búsqueda MEDLINE.
Incluye artículos publicados entre enero de 2004 y febrero de 2015.
Se analizaron nueve ensayos controlados aleatorios sobre terapia endoscópica o quirúrgica.

Principales resultados:

Se debe sospechar a la achalasia en pacientes con disfagia, dolor en el pecho o reflujo refractario sin obstrucción mecánica.
Se recomienda la manometría para la sospecha de acalasia.
La dilatación neumática (70%-90%) y la miotomía laparoscópica (88%-95%) son tratamientos efectivos para la alteración del esfínter esofágico inferior.
El pronóstico varía según el subtipo de acalasia: el tipo II muestra resultados altamente favorables (96%), el tipo I intermedio (81%) y el tipo III menos favorable (66%).

Conclusiones:

Considere la acalasia en disfagia inexplicable, especialmente cuando la obstrucción o la inflamación está ausente.
La respuesta al tratamiento en la acalasia está significativamente influenciada por el subtipo específico identificado.

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