ArticlePloS one2018
A clinical study of peroral endoscopic myotomy reveals that impaired lower esophageal sphincter relaxation in achalasia is not only defined by high-resolution manometry.
Article in PloS one, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 1 of them a synthesis that pooled it.
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15 citing papers in PubMed, 1 synthesis or guideline pooled it, 17 citations in OpenAlex.
- Pooled it
- Pneumatic dilation, evaluation of compliance of esophagogastric junction by Pneumatic dilation balloon before POEM.Surgical endoscopy · 2026Article
- Article
- Development of a diagnostic model for esophageal achalasia assessed by esophageal high-resolution manometry using artificial intelligence.Experimental and therapeutic medicine · 2026Article
- Persistent body-weight change on achalasia and peroral endoscopic myotomy: a multicenter cohort study.Journal of gastroenterology · 2025Observational
- Assessment of the Physical Invasiveness of Peroral Endoscopic Myotomy during the Perioperative Period Based on Changes in Energy Metabolism.Metabolites · 2023Article
- Pathogenesis, clinical manifestations, diagnosis, and treatment progress of achalasia of cardia.World journal of clinical cases · 2023Review
- Subtype of Achalasia and Integrated Relaxation Pressure Measured Using the Starlet High-resolution Manometry System: A Multicenter Study in Japan.Journal of neurogastroenterology and motility · 2022Article
- Effect of esophageal muscle fibrosis on prognosis of per-oral endoscopic myotomy (POEM) in achalasia patients.Surgical endoscopy · 2022Article
- Esophageal Diverticulum - Indications and Efficacy of Therapeutic Endoscopy.Internal medicine (Tokyo, Japan) · 2022Article
- Effects of the preoperative IRP values on the pathophysiology of patients with esophageal achalasia and on the treatment outcome of laparoscopic Heller-Dor surgery.Langenbeck's archives of surgery · 2021Article
- Characteristics of a Subset of Achalasia With Normal Integrated Relaxation Pressure.Journal of neurogastroenterology and motility · 2020Article
- Multicenter collaborative retrospective evaluation of peroral endoscopic myotomy for esophageal achalasia: analysis of data from more than 1300 patients at eight facilities in Japan.Surgical endoscopy · 2020Article
- Epidemiological analysis of achalasia in Japan using a large-scale claims database.Journal of gastroenterology · 2019Article
- Esophageal Third Space Endoscopy: Recent Advances.Current treatment options in gastroenterology · 2019Review
Corrections and comments
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Authors and funding
6 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
BACKGROUND AND
aimAchalasia is an esophageal motility disorder characterized by impaired lower esophageal sphincter (LES) relaxation. On high-resolution manometry (HRM), impaired LES relaxation is defined by elevated integrated relaxation pressure (IRP). However, a new category of achalasia within the normal IRP range has been suggested.
methodsHRM was performed using a Starlet device and an IRP threshold of 26 mmHg. Peroral endoscopic myotomy (POEM) was performed for cases of achalasia diagnosed using established methods. During POEM, the histology of the LES was assessed. Follow-up was performed 2 months post-operatively.
resultsForty-one patients with achalasia (18 women, mean age 53 ± 18.6 years) were included. Among them, 27 were placed in the IRP > 26 mmHg subgroup (impaired LES relaxation on HRM) and 14 in the IRP ≤ 26 mmHg subgroup (normal LES relaxation on HRM). In the IRP ≤ 26 mmHg subgroup, patients were older, had longer symptom duration, and had more esophageal dilation. The IRP ≤ 26 mmHg subgroup had the same symptom severity as the higher IRP subgroup and POEM significantly improved symptoms and IRP, although four patients still had severe LES fibrosis.
conclusionsThe clinical presentation of achalasia has a gap between a HRM-defined impaired LES relaxation, with aging or disease progression considered reasons for a lowered LES pressure. POEM can be a feasible treatment option, even for cases of achalasia with a normal IRP. However, patients with severe LES fibrosis need more attention for the therapeutic indication.
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