Diagnostic evaluation of achalasia: from the whalebone to the Chicago classification.

From the earliest description of dysphagia relieved by dilatation with a whalebone in 1674 we have witnessed the evolution of esophageal function testing from the conventional manometry to the high-resolution manometry (HRM) and esophageal topography pressure plotting that have led to the revised Chicago classification for esophageal motility disorders in 2014. The goals of this paper are, therefore, (1) to highlight the historical milestones that have led to the diagnostic definition of achalasia, as we know it today; (2) to describe the evaluation process of patients with suspected achalasia; (3) to describe the diagnostic value of the HRM and the usefulness of the Chicago classification in predicting treatment outcomes. The value of Chicago classification is linked to the ability of the clinician to perform a thorough clinical evaluation to identify and correlate specific clinical phenotypes to specific manometric subtypes and predict treatment outcomes. Chicago classification, however, cannot predict which treatment, pneumatic dilatation, or Heller myotomy, should be selected for those with a specific subtype of achalasia.

Per-oral endoscopic myotomy: major advance in achalasia treatment and in endoscopic surgery.

Per-oral endoscopic myotomy (POEM) represents a natural orifice endoscopic surgery (NOTES) approach to laparoscopy Heller myotomy (LHM). POEM is arguably the most successful clinical application of NOTES. The growth of POEM from a single center in 2008 to approximately 60 centers worldwide in 2014 with several thousand procedures having been performed attests to the success of POEM. Initial efficacy, safety and acid reflux data suggest at least equivalence of POEM to LHM, the previous gold standard for achalasia therapy. Adjunctive techniques used in the West include impedance planimetry for real-time intraprocedural luminal assessment and endoscopic suturing for challenging mucosal defect closures during POEM. The impact of POEM extends beyond the realm of esophageal motility disorders as it is rapidly popularizing endoscopic submucosal dissection in the West and spawning offshoots that use the submucosal tunnel technique for a host of new indications ranging from resection of tumors to pyloromyotomy for gastroparesis.

From Heller to POEM (1914-2014): a 100-year history of surgery for Achalasia.

BACKGROUND: The year 2014 marks the 100th anniversary of Dr. Heller's description of the surgical treatment of patients with achalasia with a cardiomyotomy. This 100-year-old operation, which is today performed laparoscopically with the addition of a partial fundoplication, is considered the treatment of choice for patients with achalasia. PURPOSE: Our goals are to revisit the accounts from the beginning of the twentieth century in which surgeons tried to identify the pathophysiology of achalasia and proposed several operative techniques and to follow the evolution of the surgical treatment until modern days.

Laparoscopic upper gut surgery.

Australian surgeons have been prominent in the introduction, development, and consolidation of laparoscopic surgery of the upper gut. In doing this, some of the very best principles of surgical innovation have been in evidence: preliminary animal work in which to test hypotheses and techniques, followed by careful application and documentation in the clinical setting, randomized clinical trials and finally academic reporting and ongoing development. This review documents the introduction of laparoscopic surgery for gastroesophageal reflux, hiatus hernia, achalasia, gastroesophageal malignancy, obesity, and a range of emergency conditions in Australia. Those involved are regarded as world leaders in their field. A vital component of this success has been the close cooperation between surgeons and gastroenterologists within the Gastroenterological Society of Australia.

A viagem científica de Neiva e Penna: roteiro para os estudos das doenças do sertão / The scientific journey of Neiva and Penna: a route for studies of diseases from the Brazilian hinterland

Analisa o relatório de Arthur Neiva e Belisario Penna , focalizando a contribuição dos autores ao estudo de uma das doenças endêmicas por eles encontrada ao longo de todo o trajeto percorrido, de longa data conhecida popularmente por 'mal de engasgo'. Observaram e descreveram com minúcia os sintomas apresentados pelos doentes e a associação frequente do mal de engasgo com outro mal endêmico conhecido por 'vexame' ou 'vexame do coração', que consistia em crises de palpitações. Os estudos epidemiológicos e clínicos de Neiva e Penna sobre o mal de engasgo muito contribuíram para o conhecimento dessa afecção e representaram um incentivo para todos os pesquisadores que se dedicaram ao seu estudo, especialmente quanto a sua relação com a doença de Chagas.(AU)

Participação de Carlos Chagas e seus colaboradores no conhecimento e reconhecimento do megaesôfago de etiologia chagásica / Participation of Carlos Chagas and his collaborators in the knowledge and recognition of the mega oesophagus of chagasic aetiology

Revê-se a participação de Carlos Chagas e colaboradores mais próximos no reconhecimento e detecção do megaesôfago chagásico, através de registros feitos em alguns trabalhos pioneiros. A disperistalse é claramente mencionada e bem descrita em observações originais por eles realizadas em áreas endêmicas e material hospitalar. Revê-se a indagação de Chagas quanto à possibilidade da etiologia esquizotripanósica do agravo, em 1916, assunto que não retoma em trabalhos posteriores. Na oportunidade, são discutidos alguns fatos eventualmente explicativos a respeito desta história.

Historical perspective of achalasia.

This article provides an overview of the historic background of achalasia. It describes how achalasia was first chronicled in the 17th century. Prevalent theories of etiology from the original description to present day constructs are examined. Important individuals and their contributions to the concepts of achalasia are reviewed and various nonsurgical and surgical therapeutic techniques from antiquity to today are presented.

Why history is important for thoracic surgeons.

There are numerous examples of lessons to be learned from acquaintance with surgical history. Notwithstanding these considerations--the admonition to read and think about history, the lessons learned from technical misadventures, and the need to add humanistic practices to our scientific endeavors--the real reward from our study of medical history lies in the pure job of being educated in one more way. This implies understanding our contemporary position in the unrolling course of medical history: from remote history through the enlightenment after the reawakening from the dark ages, to the surgical spurt in the latter half of the nineteenth century, and onward through the dramatic advances of our passing millennium.

A singular história dos megas chagásicos / The unique history of the Chagas esophageal achalasia

Mostra como a pesquisa sobre o mal de engasgo (o megaesôfago) passou da suposiçäo de Chagas em 1916 para a redescoberta das consequências tardias da "moléstia de Chagas", 31 anos depois, com os trabalhos e a tese de Pedreira de Freitas em 1946/47. Considera que as conclusöes de Arthur Neiva e Belisario Penna afastaram eventuais cogitaçöes sobre o Trypanosoma cruzi e que Chagas teve um estranho desinteresse pelo esclarecimento do mal de engasgo. Segundo o autor, estes foram os acontecimentos com suas consequências próximas e tardias que atrasaram por 31 anos a soluçäo dos megas chagásicos.(AU)

[A missing name in the history of chagasic megaesophagus: Joseph Cooper Reinhardt (1809/10-1873)]. / Um nome que faltava na história do megaesôfago chagásico: Joseph Cooper Reinhardt (1809/10-1873).

The book entitled "Brazil and the Brasilians", written by the Reverends Kidder and Fletcher and firstly published in the United States in 1857, reports the travels of these two missionaries throughout Brazil and includes a section entitled "A new disease". This section contains data regarding the clinical picture, the natural history and the epidemiology of a commom disease in Brazilian hinterland, which was known as "mal de engasgo". These informations were collected in 1855 by Rev. Fletcher from an anonymous North American physician, who worked in Limeira, State of São Paulo, and is called in the book merely as "Dr.-". The present work reports the results of an investigation carried out aiming at the identification of "Dr.-" and discloses documental evidence that "Dr.-" was actually Dr. Joseph Cooper Reinhardt (1809/10-1883). Dr. Reinhardt worked for many years in the citites of Limeira and Campinas, State of São Paulo, and probably had an extensive knowledge regarding the main features of this particular disease, which would be known, nearly 100 years later, as chagasic megaesophagus. The authors point out that, from now on, any account of the history of chagasic megaesophagus must include the name of Dr. Joseph Cooper Reinhardt.

Um nome que faltava na história do megaesôfago chagásico: Joseph Cooper Reinhardt (1809/10-1873) / A missing name in the history of chagasic megaesophagus: Joseph Cooper Reinhardt (1809/10-1873)

No livro "Brazil and the Brazilians" escrito pelos reverendos Kidder e Fletcher, publicado nos Estados Unidos em primeira ediçao em 1857 e que relata viagens destes dois missionários pelo Brasil, há um sub-capítulo intitulado "A new disease". Ali sao revelados dados do quadro clínico, da evoluçao, da endemicidade e da distribuiçao geográfica de doença comum nos sertoes brasileiros e que era conhecida como mal de engasgo. As informaçoes sobre a doença foram prestadas a Fletcher, em 1855, em Limeira (SP), por um médico norte-americano mantido no anonimato na obra citada, designado apenas como Dr. -. Os autores relatam as investigaçoes conduzidas no sentido de identificar o Dr. - e revelam provas documentais que demonstram, cabalmente, ter sido ele o Dr. Joseph Cooper Reinhardt (1809/10-1873). Este médico clinicou, por muitos anos, nas cidades de Limeira (SP) e Campinas (SP). As informaçoes que deu a Fletcher denotam que ele tinha notável conhecimento sobre as características da doença que, cerca de 100 anos mais tarde, seria conhecida como megaesôfago chagásico. Os autores opinam que, doravente, este nome deve ser mençao indispensável quando se contar a história do megaesôfago chagásico.

Miguel Dias Pimenta (1661-1715) e a história do megaesôfago e do megacólon chagásicos / Miguel Dias Pimenta (1661-1715) and the history of chagasic megaesophagus and megacolon

Procurou-se analisar, sob o ponto de vista clínico, as descriçoes contidas no livro "Noticias do que he o achaque do bicho", de Miguel Dias Pimenta (1661-1715), que sao consideradas por alguns autores como as primeiras referências ao megaesôfago e ao megacólon chagásicos que aparecem na história. Nas descriçoes tidas como referentes ao megaesôfago, além de nao se reconhecer a disfagia, o principal sintoma desta doença, identificam-se manifestaçoes próprias de afecçao irritativa, inflamatória ou ulcerativa nao do esôfago, mas do estômago. Naquelas referidas como do megacólon, os sintomas e sinais descritos sugerem a possibilidade diagnóstica de hemorróidas e do próprio achaque do bicho, nao lembrando, em absoluto, o quadro clínico da afecçao chagásica. Assim sendo, nao há razao para que se mantenha o "Noticias do que he o achaque do bicho" dentro da história da forma digestiva da moléstia de Chagas.