treatment of achalasia

Q: Out of the following which is considered a relatively effective treatment of achalasia? 

A) isosorbide dinitrate 
B) sildenafil 
C) dicyclomine 
D) terbutaline 
E) theophylline


Answer: A 

 Surgical procedures including botulinum toxin injection remain the mainstay of treatment for achalasia. For patients who are not candidates for this, many pharmacological treatments have been proposed. Out of all, sublingual isosorbide dinitrate 10-15 minutes prior to a meal is considered the most effective. The dose is 5 mg. If isosorbide dinitrate is not available (as in the USA) sublingual nitroglycerin in a dose of 0.4 mg can be used. Side effects are headache and flushing.  

5-phosphodiesterase inhibitors (sildenafil), anticholinergics (atropine, dicyclomine, cimetropium bromide), beta-adrenergic agonists (terbutaline), and theophylline have been tried but so far failed to show any successful results. Short-acting Calcium Channel blockers have been proposed but should be avoided as it can cause hemodynamic collapse.

#surgical-critical-care
#gastroenterology


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.