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  • Review Article
  • Published:

Therapeutic options in oesophageal dysphagia

Nature Reviews Gastroenterology & Hepatology volume 12, pages 332–341 (2015)Cite this article

Subjects

Key Points

  • Pneumatic dilation has been recommended as the preferred first-line therapy for type I and type II achalasia, especially in patients >45 years of age

  • Heller myotomy is the treatment of choice for young patients with achalasia, and in type III achalasia

  • Some patients with oesophageal hypercontractility disorders might respond to botulinum toxin injection

  • Ongoing studies are evaluating the role of peroral endoscopic myotomy in the management of achalasia and oesophageal hypercontractility disorders

  • Dysphagia in patients with oesophageal hypocontractility is challenging, and therapies with proven efficacy are lacking

Abstract

High-resolution manometry enables the categorization of patients with oesophageal dysphagia caused by oesophageal motility disorders into diagnostic categories according to the Chicago Classification. This Review provides an overview of the literature concerning treatment options for patients with dysphagia associated with achalasia, hypercontractile disorders and hypocontractility disorders of the oesophagus. In achalasia, pharmacotherapy and botulinum toxin are less effective than pneumatic dilation or surgical Heller myotomy, which had comparable efficacy in the largest controlled trial to date. Peroral endoscopic myotomy is a novel therapeutic modality that is currently being evaluated in controlled trials versus pneumatic dilation or surgical myotomy. A variety of medical treatments have been evaluated in hypermotility disorders, but only botulinum toxin injection yielded favourable results in a single controlled trial. Few studies have addressed the treatment of dysphagia in patients with oesophageal hypomotility. A variety of prokinetic agents have been studied, but there is no evidence of clinically relevant efficacy from controlled trials.

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Authors and Affiliations

  1. Translational Research Center for Gastrointestinal Disorders, KU Leuven, Herestraat 49, Leuven, 3000, Belgium

    Jan Tack

  2. Department of Surgery and Cancer, Imperial College, St Mary's Hospital, Praed Street, London, W2 1NY, Paddington, UK

    Giovanni Zaninotto

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  1. Jan Tack
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  2. Giovanni Zaninotto
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Both authors contributed equally to this manuscript.

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Correspondence to Jan Tack.

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Tack, J., Zaninotto, G. Therapeutic options in oesophageal dysphagia. Nat Rev Gastroenterol Hepatol 12, 332–341 (2015). https://doi.org/10.1038/nrgastro.2015.45

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