Project
Achalasia: from pathophysiology to treatment
Achalasia is a rare oesophageal motility disorder characterized by the absence of oesophageal peristalsis and a defective swallow-induced relaxation of the lower oesophageal sphincter. The current treatment consists of disruption of the lower oesophageal sphincter by pneumatic dilatation or laparoscopic Heller’s myotomy. In 2013, a large randomised prospective multi-centre trial was started comparing the outcome both treatments. I will analyse the 10 years or more follow-up data of this trial. Additionally, I will follow-up patients included in a more recent international randomised trial which is coordinated by prof. Boeckxstaens. In this trial the outcome of per oral endoscopic mytomy (POEM), a novel minimal invasive technique, will be compared to pneumodilatation. After two years of follow up, I will analyse the dataset in collaboration with a statistician. Third, to date achalasia symptoms are “quantified” using the Eckhardt score, a rather simple and insensitive tool. In the POEM versus pneumodilation trial, a more detailed symptom questionnaire was included with the main aim to better estimate the degree of dysphagia and improve the criteria to decide on clinical success. Symptoms scores obtained with the new questionnaire and the Eckardt score will be related to oesophageal emptying scores and clinical success rates. Finally, tissue from the the lower esophagal sfincter of achalasia patients and controls will be collected. Single cells will be isolated to perform single cell RNA sequencing in order to detect differences in cell populations and identify signaling pathways involved in the pathogenesis of achalasia.