Diagnostics and Treatment of Esophageal Achalasia (Clinical Guidelines of the Russian Gastroenterological Association, Russian Scientific Medical Society of Internal Medicine, Russian Society for the Prevention of Noncommunicable Diseases, REndO Endo

Aim: to familiarize gastroenterologists, therapists, functional diagnostics and general practitioners (family doctors), radiologists, and endoscopists with modern methods of diagnosis and treatment of achalasia of the cardia. Key points. Achalasia is an idiopathic neuromuscular disease manifested by a functional disorder of the patency of the cardia due to a lack of coordination between swallowing, reflex opening of the lower esophageal sphincter, and the motor and tonic activity of the smooth muscles of the esophagus. The etiology of achalasia remains unclear. However, it is believed that the key role belongs to the changes in the myenteric (Auerbach’s) intermuscular plexus of the enteric nervous system of the esophagus, leading to loss of neuronal function. The following hypotheses have been proposed as the main mechanisms for the development of achalasia: genetic predisposition, exposure to viral infections, and idiopathic autoimmune triggers. Patients with suspected achalasia require a comprehensive instrumental examination, including esophagogastroduodenoscopy, timed barium esophagogram, and esophageal manometry. In recent years, high-resolution esophageal manometry has been recognized as the gold standard for achalasia diagnostics. To analyse the obtained data, the Chicago classification is recommended — it allows to ascertain the type of achalasia, which determines the choice of treatment method and the assessment of the prognosis of the therapy effectiveness. Treatment of achalasia can be pharmacological, endoscopic (pneumatic balloon dilation, peroral endoscopic myotomy, botulinum toxin injection), aimed at regulating the tone and motility of the esophagus and cardia while preserving all anatomical structures, and surgical (laparoscopic esophagocardiomyotomy, esophagectomy), in which the muscle fibers of the esophagus and esophagogastric junction are intersected or the altered esophagus is completely removed with simultaneous formation of an artificial esophagus from the stomach or colon (esophagoplasty). Conclusion. Implementation of the developed clinical guidelines can help to establish a diagnosis in a timely manner, which will lead to an improvement in the quality of medical care for patients with achalasia.