{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T02:49:04Z","timestamp":1784774944398,"version":"3.55.0"},"reference-count":30,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2024,1,29]],"date-time":"2024-01-29T00:00:00Z","timestamp":1706486400000},"content-version":"vor","delay-in-days":2,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,4,27]]},"abstract":"<jats:title>Summary<\/jats:title>\n               <jats:p>Achalasia is a rare esophageal disorder characterized by abnormal esophageal motility and swallowing difficulties. Pain and\/or spasms often persist or recur despite effective relief of the obstruction. A survey by UK charity \u2018Achalasia Action\u2019 highlighted treatments for achalasia pain\/spasms as a key research priority. In this patient-requested systematic review, we assessed the existing literature on pharmacological therapies for painful achalasia. A systematic review of the literature using Medline, Embase and Cochrane databases was performed to identify studies evaluating pharmacological therapies for achalasia. Methodological quality of included randomized controlled trials was assessed using the Cochrane Risk of Bias tool. In total, 70% (40\/57) of survey respondents reported experiencing pain\/spasms. A range of management strategies were reported. Thirteen studies were included in the review. Seven were randomized controlled trials. Most studies were\u2009&amp;gt;30\u00a0years old, had limited follow-up, and focussed on esophageal manometry as the key endpoint. Generally, studies found improvements in lower esophageal pressures with medications. Only one study evaluated pain\/spasm specifically, precluding meta-analysis. Overall risk of bias was high. The achalasia patient survey identified that pain\/spasms are common and difficult to treat. This patient-requested review identified a gap in the literature regarding pharmacological treatments for these symptoms. We provide an algorithm for investigating achalasia-related pain\/spasms. Calcium channel blockers or nitrates may be helpful when esophageal obstruction and reflux have been excluded. We advocate for registry-based clinical trials to expand the evidence base for these patients.<\/jats:p>","DOI":"10.1093\/dote\/doae005","type":"journal-article","created":{"date-parts":[[2024,1,29]],"date-time":"2024-01-29T03:44:55Z","timestamp":1706499895000},"source":"Crossref","is-referenced-by-count":6,"title":["Medical management of painful achalasia: a patient-driven systematic review"],"prefix":"10.1093","volume":"37","author":[{"given":"Solange","family":"Bramer","sequence":"first","affiliation":[{"name":"General Surgery, Barnet Hospital , London , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda","family":"Ladell","sequence":"additional","affiliation":[{"name":"Achalasia Action , London , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah","family":"Glatzel","sequence":"additional","affiliation":[{"name":"Trauma & Orthopaedics, Stoke Mandeville Hospital , Aylesbury , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alan","family":"Moss","sequence":"additional","affiliation":[{"name":"Achalasia Action , London , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Majid","family":"Hashemi","sequence":"additional","affiliation":[{"name":"Upper Gastrointestinal Service, University College London , London , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Zaninotto","sequence":"additional","affiliation":[{"name":"Department of Surgery and Cancer, Imperial College London , London , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Antonowicz","sequence":"additional","affiliation":[{"name":"Department of Surgery and Cancer, Imperial College London , London , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,1,27]]},"reference":[{"issue":"7","key":"2024043013410302200_ref1","doi-asserted-by":"crossref","first-page":"e14182","DOI":"10.1111\/nmo.14182","article-title":"Chicago classification update (version 4.0): technical review on diagnostic criteria for achalasia","volume":"33","author":"Khan","year":"2021","journal-title":"Neurogastroenterol Motil Off J Eur Gastrointest Motil Soc"},{"issue":"19","key":"2024043013410302200_ref2","doi-asserted-by":"crossref","first-page":"1807","DOI":"10.1056\/NEJMoa1010502","article-title":"Pneumatic dilation versus laparoscopic Heller\u2019s myotomy for idiopathic achalasia","volume":"364","author":"Boeckxstaens","year":"2011","journal-title":"N Engl J Med"},{"issue":"9","key":"2024043013410302200_ref3","doi-asserted-by":"crossref","first-page":"1393","DOI":"10.14309\/ajg.0000000000000731","article-title":"ACG clinical guidelines: diagnosis and Management of Achalasia","volume":"115","author":"Vaezi","year":"2020","journal-title":"Am J Gastroenterol"},{"issue":"1","key":"2024043013410302200_ref4","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1177\/2050640620903213","article-title":"European guidelines on achalasia: united European gastroenterology and European Society of Neurogastroenterology and Motility recommendations","volume":"8","author":"Oude Nijhuis","year":"2020","journal-title":"United Eur Gastroenterol J"},{"key":"2024043013410302200_ref5","volume-title":"Achalasia Action Charity Homepage","author":"Achalasia Action"},{"issue":"1","key":"2024043013410302200_ref6","first-page":"131","article-title":"Mapping the experiences of people with achalasia from initial symptoms to long-term management","volume":"24","author":"Kalantari","year":"2021","journal-title":"Health Expect Int J Public Particip Health Care Health Policy"},{"key":"2024043013410302200_ref7","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"issue":"3","key":"2024043013410302200_ref8","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1007\/BF01318193","article-title":"Medical treatment of esophageal achalasia. Double-blind crossover study with oral nifedipine, verapamil, and placebo","volume":"36","author":"Triadafilopoulos","year":"1991","journal-title":"Dig Dis Sci"},{"issue":"1","key":"2024043013410302200_ref9","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1016\/0016-5085(81)90187-6","article-title":"Clinical and manometric effects of nifedipine in patients with esophageal achalasia","volume":"80","author":"Bortolotti","year":"1981","journal-title":"Gastroenterology"},{"issue":"1","key":"2024043013410302200_ref10","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1159\/000007583","article-title":"Medical therapy of achalasia: a benefit reserved for few","volume":"60","author":"Bortolotti","year":"1999","journal-title":"Digestion"},{"issue":"6","key":"2024043013410302200_ref11","doi-asserted-by":"crossref","first-page":"604","DOI":"10.1136\/gut.32.6.604","article-title":"Prospective clinical and manometric study comparing pneumatic dilatation and sublingual nifedipine in the treatment of oesophageal achalasia","volume":"32","author":"Coccia","year":"1991","journal-title":"Gut"},{"issue":"5","key":"2024043013410302200_ref12","doi-asserted-by":"crossref","first-page":"963","DOI":"10.1016\/S0016-5085(82)80062-0","article-title":"Isosorbide dinitrate and nifedipine treatment of achalasia: a clinical, manometric and radionuclide evaluation","volume":"83","author":"Gelfond","year":"1982","journal-title":"Gastroenterology"},{"issue":"4","key":"2024043013410302200_ref13","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1093\/ageing\/23.4.280","article-title":"Achalasia of the oesophagus in elderly patients responds poorly to conservative therapy","volume":"23","author":"Ghosh","year":"1994","journal-title":"Age Ageing"},{"issue":"6","key":"2024043013410302200_ref14","doi-asserted-by":"crossref","first-page":"768","DOI":"10.1136\/gut.30.6.768","article-title":"Quantitative assessment of the response to therapy in achalasia of the cardia","volume":"30","author":"Robertson","year":"1989","journal-title":"Gut"},{"issue":"10","key":"2024043013410302200_ref15","first-page":"1259","article-title":"The role of nifedipine therapy in achalasia: results of a randomized, double-blind, placebo-controlled study","volume":"84","author":"Traube","year":"1989","journal-title":"Am J Gastroenterol"},{"issue":"134","key":"2024043013410302200_ref16","first-page":"1611","article-title":"Diagnosis and treatment of achalasia patients: a ten-year review of the clinical features","volume":"61","author":"Yasawy","year":"2014","journal-title":"Hepatogastroenterology"},{"issue":"4","key":"2024043013410302200_ref17","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1136\/gut.22.4.312","article-title":"Effect of nitrates on LOS pressure in achalasia: a potential therapeutic aid","volume":"22","author":"Gelfond","year":"1981","journal-title":"Gut"},{"issue":"1","key":"2024043013410302200_ref18","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1097\/00004836-198202000-00003","article-title":"Radionuclide confirmation of the therapeutic value of isosorbide dinitrate in relieving the dysphagia in achalasia","volume":"4","author":"Rozen","year":"1982","journal-title":"J Clin Gastroenterol"},{"issue":"4","key":"2024043013410302200_ref19","doi-asserted-by":"crossref","first-page":"386","DOI":"10.1097\/00004836-198708000-00006","article-title":"The effect of terbutaline sulfate, nitroglycerin, and aminophylline on lower esophageal sphincter pressure and radionuclide esophageal emptying in patients with achalasia","volume":"9","author":"Wong","year":"1987","journal-title":"J Clin Gastroenterol"},{"issue":"2","key":"2024043013410302200_ref20","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1016\/S0016-5085(00)70206-X","article-title":"Effects of sildenafil on esophageal motility of patients with idiopathic achalasia","volume":"118","author":"Bortolotti","journal-title":"Gastroenterology"},{"issue":"2","key":"2024043013410302200_ref21","first-page":"124","article-title":"Esophageal Manometry in patients with chest pain and normal coronary arteriogram","volume":"75","author":"Ferguson","year":"1981","journal-title":"Am J Gastroenterol"},{"issue":"8","key":"2024043013410302200_ref22","doi-asserted-by":"crossref","first-page":"2214","DOI":"10.1007\/s10620-019-05523-8","article-title":"Impact of peppermint therapy on dysphagia and non-cardiac chest pain: a pilot study","volume":"64","author":"Khalaf","year":"2019","journal-title":"Dig Dis Sci"},{"issue":"1","key":"2024043013410302200_ref23","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1097\/00004836-200107000-00007","article-title":"Peppermint oil improves the manometric findings in diffuse esophageal spasm","volume":"33","author":"Pimentel","year":"2001","journal-title":"J Clin Gastroenterol"},{"issue":"3","key":"2024043013410302200_ref24","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1067\/mhj.2000.108514","article-title":"Randomized trial of sertraline in patients with unexplained chest pain of noncardiac origin","volume":"140","author":"Varia","year":"2000","journal-title":"Am Heart J"},{"issue":"20","key":"2024043013410302200_ref25","doi-asserted-by":"crossref","first-page":"1411","DOI":"10.1056\/NEJM199405193302003","article-title":"Imipramine in patients with chest pain despite normal coronary angiograms","volume":"330","author":"Cannon","year":"1994","journal-title":"N Engl J Med"},{"issue":"4","key":"2024043013410302200_ref26","doi-asserted-by":"crossref","first-page":"1027","DOI":"10.1016\/0016-5085(87)90979-6","article-title":"Low-dose trazodone for symptomatic patients with esophageal contraction abnormalities. A double-blind, placebo-controlled trial","volume":"92","author":"Clouse","year":"1987","journal-title":"Gastroenterology"},{"issue":"6","key":"2024043013410302200_ref27","doi-asserted-by":"crossref","first-page":"758","DOI":"10.1136\/gut.50.6.758","article-title":"Effect of sildenafil on oesophageal motor function in healthy subjects and patients with oesophageal motor disorders","volume":"50","author":"Eherer","year":"2002","journal-title":"Gut"},{"issue":"2","key":"2024043013410302200_ref28","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1097\/00000658-200202000-00005","article-title":"Etiology, diagnosis, and treatment of failures after laparoscopic Heller myotomy for achalasia","volume":"235","author":"Zaninotto","year":"2002","journal-title":"Ann Surg"},{"issue":"18","key":"2024043013410302200_ref29","doi-asserted-by":"crossref","first-page":"1841","DOI":"10.1001\/jama.2015.2996","article-title":"Achalasia: a systematic review","volume":"313","author":"Pandolfino","year":"2015","journal-title":"JAMA"},{"key":"2024043013410302200_ref30","volume-title":"British National Formulary","author":"Joint Formulary Committee","year":"2022"}],"container-title":["Diseases of the Esophagus"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/dote\/article-pdf\/37\/5\/doae005\/57345754\/doae005.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/dote\/article-pdf\/37\/5\/doae005\/57345754\/doae005.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,4,30]],"date-time":"2024-04-30T13:41:31Z","timestamp":1714484491000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/dote\/article\/doi\/10.1093\/dote\/doae005\/7590533"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1,27]]},"references-count":30,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2024,1,27]]},"published-print":{"date-parts":[[2024,4,27]]}},"URL":"https:\/\/doi.org\/10.1093\/dote\/doae005","relation":{},"ISSN":["1120-8694","1442-2050"],"issn-type":[{"value":"1120-8694","type":"print"},{"value":"1442-2050","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2024,5]]},"published":{"date-parts":[[2024,1,27]]},"article-number":"doae005"}}