J Neurogastroenterol Motil.  2020 Apr;26(2):180-203. 10.5056/jnm20014.

2019 Seoul Consensus on Esophageal Achalasia Guidelines

Affiliations
  • 1Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
  • 2Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea
  • 3Department of Internal Medicine, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, Korea
  • 4Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
  • 5Division of Gastroenterology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
  • 6Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Mukogawa-cho, Nishinomiya, Hyogo, Japan
  • 7Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
  • 8Division of Gastroenterology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
  • 9Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
  • 10Gastro Centre, Ipoh, Malaysia
  • 11Division of Gastroenterology and Hepatology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
  • 12Department of Internal Medicine, College of Medicine, Soonchunhyang University Hospital, Seoul, Korea
  • 13Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
  • 14Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
  • 15Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Korea
  • 16Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
  • 17Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Gangwon-do, Korea
  • 18Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, University of Ulsan College of Medicine, Seoul, Korea
  • 19Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
  • 20Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
  • 21Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
  • 22Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea
  • 23Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
  • 24Department of Internal Medicine and Digestive Disease Research Institute, Wonkwang University School of Medicine, Iksan, Korea
  • 25Department of Gastroenterology and Hepatology, Tokai University School of Medicine, Isehara, Kanagawa, Japan
  • 26Department of Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
  • 27Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong, China
  • 28Department of Gastroenterology, Ajou University School of Medicine, Suwon, Gyeonggi-do, Korea
  • 29Department of Gastroenterology, Kobe University Hospital, Hyogo, Japan
  • 30Division of Gastroenterology and Hepatology, National University Health System, Singapore City, Singapore
  • 31Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea

Abstract

Esophageal achalasia is a primary motility disorder characterized by insufficient lower esophageal sphincter relaxation and loss of esophageal peristalsis. Achalasia is a chronic disease that causes progressive irreversible loss of esophageal motor function. The recent development of high-resolution manometry has facilitated the diagnosis of achalasia, and determining the achalasia subtypes based on high-resolution manometry can be important when deciding on treatment methods. Peroral endoscopic myotomy is less invasive than surgery with comparable efficacy. The present guidelines (the “2019 Seoul Consensus on Esophageal Achalasia Guidelines”) were developed based on evidence-based medicine; the Asian Neurogastroenterology and Motility Association and Korean Society of Neurogastroenterology and Motility served as the operating and development committees, respectively. The development of the guidelines began in June 2018, and a draft consensus based on the Delphi process was achieved in April 2019. The guidelines consist of 18 recommendations: 2 pertaining to the definition and epidemiology of achalasia, 6 pertaining to diagnoses, and 10 pertaining to treatments. The endoscopic treatment section is based on the latest evidence from meta-analyses. Clinicians (including gastroenterologists, upper gastrointestinal tract surgeons, general physicians, nurses, and other hospital workers) and patients could use these guidelines to make an informed decision on the management of achalasia.

Keyword

Esophageal achalasia; Esophageal motility disorders; Guideline; Manometry; Myotomy
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