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Herbella et al. Mini-invasive Surg 2017;1:115-6 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2017.28
www.misjournal.net
Topic: Achalasia Management: the South American Viewpoint Open Access

Achalasia management: the South

American viewpoint

Fernando A.M. Herbella, Leonardo M. Del Grande
Department of Surgery, Escola Paulista de Medicina, Federal University of São Paulo, Sao Paulo, SP 04037-003, Brazil.

Correspondence to: Dr. Fernando A.M. Herbella, Department of Surgery, Escola Paulista de Medicina, Rua Diogo de Faria 1087 cj 301, Sao Paulo,
SP 04037-003, Brazil. E-mail: herbella.dcir@epm.br

How to cite this article: Herbella FAM, Del Grande LM. Achalasia management: the South American viewpoint. Mini-invasive Surg 2017;1:115-6.
Article history: Received: 20 Jul 2017 Accepted: 21 Jul 2017 Published: 30 Sep 2017

Dr. Fernando A.M. Herbella is an Affiliate Professor at the Department of Surgery, Federal University of São Paulo,
Brazil, where he obtained his MD, residency training in general and GI surgery, MSc and Doctor Degrees. He did a
fellowship in esophageal physiology and surgery at the University of California, San Francisco, USA and other at the
University of Rochester, USA.

Achalasia is usually quoted as a rare primary of immigrants carry the disease worldwide. This high
[5]
esophageal disorder with an unknown etiology. This incidence of the disease in endemic areas brought
[1]
rarity leads to frequent misdiagnosis as shown by high a large experience in the management of these
rate of patients with achalasia referred for antireflux patients by South American gastroenterologists and
surgery. The two affirmatives that achalasia is rare surgeons. Unfortunately, most of this experience is
[2]
and lacks an etiology; however, may not be true in published in local languages making it grey literature
South America. In this continent, a local disease - for international readers.
Chagas disease or American trypanosomiasis - caused
by the inoculation of a parasite through a bug bite Despite several similarities, Chagas disease
leads to an esophagopathy almost indistinguishable esophagopathy is characterized by massive
from idiopathic achalasia found in other continents, as dilatation of the esophagus a finding rare in idiopathic
[6]
shown in the paper by Dr. Dantas in this seminar. achalasia. The treatment for non-advanced achalasia
is well established and based on cardiomyotomy
Chagas disease currently affects 5-18 million people (surgical or recently endoscopic) or forceful dilatation
and an estimated 15-20% will develop Chagasic of the cardia. The therapy for end-stage disease is;
[7]
esophagopathy. More than this, autochthonous however, controversial and the familiarity of these
[3]
cases of Chagas disease have been reported up to conditions by South American physicians may be
Southern United States and an uncountable number useful. Some unconventional or long-forgotten surgical
[4]
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