التفاصيل البيبلوغرافية
| العنوان: |
Medical management of painful achalasia: a patient-driven systematic review. |
| المؤلفون: |
Bramer, Solange, Ladell, Amanda, Glatzel, Hannah, Moss, Alan, Hashemi, Majid, Zaninotto, Giovanni, Antonowicz, Stefan |
| المصدر: |
Diseases of the Esophagus; May2024, Vol. 37 Issue 5, p1-10, 10p |
| مصطلحات موضوعية: |
ESOPHAGEAL motility disorders, ESOPHAGEAL achalasia, GASTROESOPHAGEAL reflux, CALCIUM antagonists, ESOPHAGEAL motility, RANDOMIZED controlled trials, SPASMS |
| مصطلحات جغرافية: |
UNITED Kingdom |
| مستخلص: |
Achalasia is a rare esophageal disorder characterized by abnormal esophageal motility and swallowing difficulties. Pain and/or spasms often persist or recur despite effective relief of the obstruction. A survey by UK charity 'Achalasia Action' highlighted treatments for achalasia pain/spasms as a key research priority. In this patient-requested systematic review, we assessed the existing literature on pharmacological therapies for painful achalasia. A systematic review of the literature using Medline, Embase and Cochrane databases was performed to identify studies evaluating pharmacological therapies for achalasia. Methodological quality of included randomized controlled trials was assessed using the Cochrane Risk of Bias tool. In total, 70% (40/57) of survey respondents reported experiencing pain/spasms. A range of management strategies were reported. Thirteen studies were included in the review. Seven were randomized controlled trials. Most studies were >30 years old, had limited follow-up, and focussed on esophageal manometry as the key endpoint. Generally, studies found improvements in lower esophageal pressures with medications. Only one study evaluated pain/spasm specifically, precluding meta-analysis. Overall risk of bias was high. The achalasia patient survey identified that pain/spasms are common and difficult to treat. This patient-requested review identified a gap in the literature regarding pharmacological treatments for these symptoms. We provide an algorithm for investigating achalasia-related pain/spasms. Calcium channel blockers or nitrates may be helpful when esophageal obstruction and reflux have been excluded. We advocate for registry-based clinical trials to expand the evidence base for these patients. [ABSTRACT FROM AUTHOR] |
|
Copyright of Diseases of the Esophagus is the property of Oxford University Press / USA and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.) |
| قاعدة البيانات: |
Complementary Index |
