Pathogenesis, clinical manifestations, diagnosis, and treatment progress of achalasia of cardia

Table 1 Classification of achalasia in the Chicago classification system

Type	Feature
I	All failed without PEP
II	All failed ≥ 20%with PEP
III	≥ 20% premature ± PEP

PEP: Pan-esophageal pressurization.

Table 2 Ling classification of achalasia cardia

Type	Endoscopic presentation
I	The lumen was slightly dilated and smooth without polyring, crescent-shaped structures, or diverticular structures
II	The lumen was dilated and polycyclic or crescent-shaped structures appeared after inflation
IIa	A thin ring, no crescent structure
IIb	Crescent structure, not more than 1/3 of the lumen
IIc	Crescent structure, more than 1/3 of the lumen
III	The lumen was significantly dilated, with the diverticular structure-like structures
IIIl	Diverticulum structure in the left wall of esophagus
IIIr	Diverticulum structure in the right wall of esophagus
IIIlr	Diverticulum structure in both the left and right walls of esophagus

Table 3 Eckardt rating table

Score	Symptom
	Weight loss	Dysphagia	Retrosternal pain	Palirrhea
0	-	-	-	-
1	< 5	Occasional	Occasional	Occasional
2	5-10	Daily	Daily	Daily
3	> 10	Every meal	Every meal	Every meal

Table 4 Radiological stages of achalasia

Radiological stage	Esophageal diameter	Esophageal shape
I	≤ 4 cm	-
II	4-6 cm	-
III	≥ 6 cm	-
IV (End-stage disease)	≥ 6 cm	Sigmoid

Table 5 Pharmacotherapy for achalasia

Type	On behalf of drugs	Mechanism of action
Calcium channel blockers	Nifedipine	Inhibit L - type calcium channel, relax smooth muscle and empty esophagus
Nitrates	Carvasin	Increase NO in tissue and relax smooth muscle
Anticholinergic	Ceto bromide ammonium bromide	Relax smooth muscle
Phosphodiesterase inhibitors	Silaenafil	Prevent the degradation of NO and prolong the relaxation of esophageal smooth muscle

Table 6 Surgical treatment of achalasia

Procedure	Indication	Complication
Peroral endoscopic myotomy	Advanced sigmoidocardia achalasia; surgical myotomy failed; patients with achalasia cardia who have previously received endoscopic treatment; spastic esophageal dyskinesia, such as jackhammer esophagus; diffuse esophageal spasm; hypertensive lower esophageal sphincter; nutcracker esophageal dyskinesia	Mucosal perforation; subcutaneous emphysema; pneumoperitoneum; pneumothorax; mediastinal emphysema; pleural effusion and pneumonia; delayed bleeding; infection; gastroesophageal reflux disease
Laparoscopic Heller myotomy	Drug treatment if symptomatic improvement is not obvious	Gastroesophageal reflux disease; punch
Stent implantation	Patients who are not candidates for surgery	Mucosal hyperplasia; local esophageal stenosis; scaffold migration
Esophagectomy	A zigzag giant esophagus; esophageal stenosis caused by reflux	Leakage