Achalasia

Q: All of the following have been described as medical treatments of Achalasia except?

A) nitrates
B)  sildenafil
C) terbutaline
D) theophylline 
E) Potassium chloride tablets


Answer: E

Achalasia is mostly a surgical disease or requires an invasive intervention like botox. Medical therapy is considered only as second-line therapy for patients who are not a candidate for invasive interventions.

Administrating short-acting nitrates 10 minutes prior to a meal helps in relaxing the smooth muscle of the Lower Esophageal Sphincter (LES) and improves the symptoms of achalasia (choice A)

5-phosphodiesterase inhibitors (choice B), anticholinergics, beta-adrenergic agonists (choice C), and theophylline (choice D) have been suggested as treatments of achalasia.

Potassium chloride tablets are usually very big in size and are known to directly damage the esophageal wall, and should be ideally avoided in achalasia.

#gastroenterology
#surgicalcriticalcare


References:

1. Wen ZH, Gardener E, Wang YP. Nitrates for achalasia. Cochrane Database Syst Rev 2004; :CD002299. 

2. Kahrilas PJ, Pandolfino JE. Treatments for achalasia in 2017: how to choose among them. Curr Opin Gastroenterol 2017; 33:270. 

3. Bassotti G, Annese V. Review article: pharmacological options in achalasia. Aliment Pharmacol Ther 1999; 13:1391.