Cost-assessment of alternative management strategies for achalasia

Marcelo F. Vela, Michael F. Vaezi

Research output: Contribution to journalReview articlepeer-review

15 Scopus citations


Achalasia is a primary oesophageal motor disorder characterised by the abnormal relaxation of the lower oesophageal sphincter (LES) and absent oesophageal peristalsis. It is a rare disease, with an estimated incidence of ∼ 1/100,000 and a prevalence close to 10/100,000 [1]. Its exact aetiology remains unknown. Autoimmune, infectious, degenerative and hereditary processes have all been proposed as factors that lead to a chronic inflammatory response in the myenteric plexus, thus resulting in selective loss of inhibitory neurons [2] and failure of the LES to relax and aperistalsis in the body of the oesophagus. The most common symptoms of achalasia are dysphagia for solids and liquids, regurgitation, chest pain, weight loss and heartburn in > 90 ∼ 75, 40 - 50, ∼ 60, ∼ 40%, respectively [3,41. The diagnosis is based on symptoms, barium swallow and manometry. A barium oesophagram typically shows a dilated oesophagus that tapers into a 'bird-beak' at the gastrooesophageal junction with lack of normal peristalsis on fluoroscopic evaluation. The characteristic manometric features of achalasia are abnormal LES relaxation and aperistalsis; additionally, the LES pressure is frequently high, but can also be normal. Current practice of medicine is faced with rising healthcare costs and limited budgets [5]. We are therefore confronted with an increasing demand to justify the value of our therapeutic interventions, not only from the risk/benefit standpoint but also from the cost perspective [6,7].

Original languageEnglish (US)
Pages (from-to)2019-2025
Number of pages7
JournalExpert Opinion on Pharmacotherapy
Issue number11
StatePublished - Nov 2003


  • Achalasia
  • Botulinum toxin
  • Dysphagia
  • Heller myotomy
  • Pneumatic dilation

ASJC Scopus subject areas

  • Pharmacology
  • Pharmacology (medical)


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