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Article: Long-term Efficacy of Combined Treatment in Patients with Idiopathic Achalasia.

Jameshorani, Maryam / Anushiravani, Amir / Fazlollahi, Narges / Hormati, Ahmad / Amani, Mohammad / Mikaeli, Javad

Middle East journal of digestive diseases

2021 Volume 13, Issue 1, Page(s) 21–26

Abstract: BACKGROUND Several treatment strategies are available to treat achalasia. Although combined therapy has been used for several years, there are limited data on long-term outcomes. We aimed to determine its long-term efficacy in patients who were resistant ...

Abstract	BACKGROUND Several treatment strategies are available to treat achalasia. Although combined therapy has been used for several years, there are limited data on long-term outcomes. We aimed to determine its long-term efficacy in patients who were resistant or those with rapid relapse. METHODS In this prospective study, we reviewed the records of 1100 patients with achalasia, who were candidates for pneumatic balloon dilatation (PBD) in our center from 1996 to 2018. We enrolled 197 patients resistant to initial treatment or with rapid relapse of symptoms after three sessions of PBD. Clinical evaluation and time barium esophagogram (TBE) were done before treatment, a month afterward, and when clinical symptoms increased in order to confirm relapse, and at the end of follow-up. RESULTS A total of 168 patients accepted combined therapy. The mean duration of follow-up was 9.04 years. Achalasia symptom score (ASS) dropped from 10.82 to 3.62 a month after treatment and was 3.09 at the end of the follow-up (
Language	English
Publishing date	2021-03-02
Publishing country	Iran
Document type	Journal Article
ZDB-ID	2623796-9
ISSN	2008-5249 ; 2008-5230
ISSN (online)	2008-5249
ISSN	2008-5230
DOI	10.34172/mejdd.2021.199
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Article: Compound Poisson frailty model with a gamma process prior for the baseline hazard: accounting for a cured fraction.

Rahmati, Maryam / Rezanejad Asl, Parisa / Mikaeli, Javad / Zeraati, Hojjat / Rasekhi, Aliakbar

Journal of applied statistics

2021 Volume 49, Issue 13, Page(s) 3377–3391

Abstract: Cox model and traditional frailty models assume that all individuals will eventually experience the event of interest. This assumption is often overlooked, and situations will arise where it is not realistic. We introduce Compound Poisson frailty model ... ...

Abstract	Cox model and traditional frailty models assume that all individuals will eventually experience the event of interest. This assumption is often overlooked, and situations will arise where it is not realistic. We introduce Compound Poisson frailty model for survival analysis to deal with populations in which some of the individuals will not experience the event of interest. This model assumes that the target population is a mixture of individuals with zero frailty and those with positive frailty. In this paper, we consider a compound Poisson frailty model for right-censored event times from a Bayesian perspective and compute the Bayesian estimator using the Markov Chain Monte Carlo method, where a Gamma process prior is adopted for the baseline hazard function. Furthermore, we evaluate the approach using simulation studies and demonstrate the methodology by analyzing the data from achalasia patient cohort.
Language	English
Publishing date	2021-07-05
Publishing country	England
Document type	Journal Article
ZDB-ID	1476802-1
ISSN	1360-0532 ; 0266-4763
ISSN (online)	1360-0532
ISSN	0266-4763
DOI	10.1080/02664763.2021.1947997
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Article ; Online: Safety and Efficacy of Graded Gradual Pneumatic Balloon Dilation in Idiopathic Achalasia Patients: A 24-Year Single-Center Experience.

Fazlollahi, Narges / Anushiravani, Amir / Rahmati, Maryam / Amani, Mohammad / Asl-Soleimani, Hossein / Markarian, Melineh / Jiang, Alice Chu / Mikaeli, Javad

Archives of Iranian medicine

2021 Volume 24, Issue 12, Page(s) 862–868

Abstract: Background: Pneumatic balloon dilation (PBD) is a first line treatment for idiopathic achalasia. Here we report the safety and efficacy of graded gradual PBD on short and long-term follow-up.: Methods: We evaluated 1370 idiopathic achalasia patients ... ...

Abstract	Background: Pneumatic balloon dilation (PBD) is a first line treatment for idiopathic achalasia. Here we report the safety and efficacy of graded gradual PBD on short and long-term follow-up. Methods: We evaluated 1370 idiopathic achalasia patients over a period of 24 years (1994-2018), prospectively. 216 patients did not undergo PBD due to comorbid diseases. Ultimately, 1092 achalasia patients were enrolled. All patients underwent graded gradual PBD, with repeat dilation if symptoms relapsed. Response to treatment was evaluated by Vantrappen scoring system. Results: Of 1092 achalasia patients, 937 patients were treated by PBD and 155 patients were treated by combined therapy (PBD 1 month after Botulinum toxin injection). In short-term follow-up, 728 of 1092 patients underwent one PBD and 77.3% of them had excellent or good response (responders), 163 patients (58.6%) who underwent two PBDs were responders, and 44 (51.2%) patients who underwent three PBDs were responders. Overall, 2193 balloon dilations were performed on 1092 patients (mean 2 PBDs/patient). Of 786 patients with long-term follow-up, 259 patients had excellent or good response with one PBD. The responders with two, three, and four or more dilations were 149, 67, and 67, respectively. The overall response rate was 69%. No any serious complications were noted by using the graded gradual method. Conclusion: Our results show that graded gradual PBD is a safe and effective method for treatment of achalasia patients, and achieves sufficient short and long-term symptomatic remission with high cumulative success rate.
MeSH term(s)	Catheterization/adverse effects ; Dilatation ; Esophageal Achalasia/therapy ; Humans ; Treatment Outcome
Language	English
Publishing date	2021-12-01
Publishing country	Iran
Document type	Journal Article
ZDB-ID	2204979-4
ISSN	1735-3947 ; 1029-2977
ISSN (online)	1735-3947
ISSN	1029-2977
DOI	10.34172/aim.2021.129
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Article ; Online: Identification of differentially expressed microRNAs in primary esophageal achalasia by next-generation sequencing.

Gholipour, Mahin / Mikaeli, Javad / Mowla, Seyed Javad / Bakhtiarizadeh, Mohammad Reza / Saghaeian Jazi, Marie / Javid, Naeme / Fazlollahi, Narges / Khoshnia, Masoud / Behnampour, Naser / Moradi, Abdolvahab

Turkish journal of biology = Turk biyoloji dergisi

2021 Volume 45, Issue 3, Page(s) 262–274

Abstract: Molecular knowledge regarding the primary esophageal achalasia is essential for the early diagnosis and treatment of this neurodegenerative motility disorder. Therefore, there is a need to find the main microRNAs (miRNAs) contributing to the mechanisms ... ...

Abstract	Molecular knowledge regarding the primary esophageal achalasia is essential for the early diagnosis and treatment of this neurodegenerative motility disorder. Therefore, there is a need to find the main microRNAs (miRNAs) contributing to the mechanisms of achalasia. This study was conducted to determine some patterns of deregulated miRNAs in achalasia. This case-control study was performed on 52 patients with achalasia and 50 nonachalasia controls. The miRNA expression profiling was conducted on the esophageal tissue samples using the next-generation sequencing (NGS). Differential expression of miRNAs was analyzed by the edgeR software. The selected dysregulated miRNAs were additionally confirmed using the quantitative reverse transcription polymerase chain reaction (qRT-PCR). Fifteen miRNAs were identified that were significantly altered in the tissues of the patients with achalasia. Among them, three miRNAs including miR-133a-5p, miR-143-3p, and miR-6507-5p were upregulated. Also, six miRNAs including miR-215-5p, miR-216a-5p, miR-216b-5p, miR-217, miR-7641 and miR-194-5p were downregulated significantly. The predicted targets for the dysregulated miRNAs showed significant disease-associated pathways like neuronal cell apoptosis, neuromuscular balance, nerve growth factor signaling, and immune response regulation. Further analysis using qRT-PCR showed significant down-regulation of hsa-miR-217 (p-value = 0.004) in achalasia tissue. Our results may serve as a basis for more future functional studies to investigate the role of candidate miRNAs in the etiology of achalasia and their application in the diagnosis and probably treatment of the disease.
Language	English
Publishing date	2021-06-23
Publishing country	Turkey
Document type	Journal Article
ZDB-ID	2046470-8
ISSN	1303-6092 ; 1303-6092
ISSN (online)	1303-6092
ISSN	1303-6092
DOI	10.3906/biy-2101-61
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Article: Assessment of Pneumatic Balloon Dilation in Patients with Symptomatic Relapse after Failed Heller Myotomy: A Single Center Experience.

Amani, Mohammad / Fazlollahi, Narges / Shirani, Shapour / Malekzadeh, Reza / Mikaeli, Javad

Middle East journal of digestive diseases

2016 Volume 8, Issue 1, Page(s) 57–62

Abstract: Unlabelled: BACKGROUND Although Heller myotomy is one of the most effective treatments for achalasia, it may be associated with early or late symptom relapse in some patients. Therefore, additional treatment is required to achieve better control of ... ...

Abstract	Unlabelled: BACKGROUND Although Heller myotomy is one of the most effective treatments for achalasia, it may be associated with early or late symptom relapse in some patients. Therefore, additional treatment is required to achieve better control of symptoms. Aim: To evaluate the safety and efficacy of pneumatic balloon dilation (PBD) in patients with symptom relapse after Heller myotomy. METHODS Thirty six post-myotomy patients were evaluated from 1993 to 2013. Six patients were excluded from the analysis because of comorbid diseases or epiphrenic diverticula. Thirty patients were treated with PBD. Primary outcome was defined as a decrease in symptom score to 4 or less and a reduction greater than 80% from the baseline in the volume of barium in timed barium esophagogram in 6 weeks. Achalasia symptom score (ASS) was assessed at 1.5, 3, 6, and 12 months after treatment and then every six months in all patients and PBD was repeated in case of symptom relapse (ASS>4). RESULTS The mean age of the patients was 45.5±13.9 years (range: 21-73). Primary outcome was observed in 25 patients (83%). The mean ASS of the patients dropped from 7.8 before treatment to 1.3±2.0 at 1.5 months after treatment (p=0.0001). The mean volume and height of barium decreased from 43.1±33.4 and 7.1±4.7 to 6.0±17.1 and 1.1±2.2, respectively (p=0.003, p=0.003). The mean duration of follow-up was 11.8±6.3 years. At the end of the study, 21 patients (70%) reported sustained good response. No major complications such as perforation or gross bleeding were seen. CONCLUSION PBD is an effective and safe treatment option for achalasia in patients with symptom relapse after Heller myotomy.
Language	English
Publishing date	2016-02-29
Publishing country	Iran
Document type	Journal Article
ZDB-ID	2623796-9
ISSN	2008-5249 ; 2008-5230
ISSN (online)	2008-5249
ISSN	2008-5230
DOI	10.15171/mejdd.2016.08
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Article: Laparoscopic Heller Myotomy for Achalasia: Experience from a Single Referral Tertiary Center.

Mirsharifi, Alireza / Ghorbani Abdehgah, Ali / Mirsharifi, Rasoul / Jafari, Mehdi / Fattah, Noor / Mikaeli, Javad / Soroush, Ahmad Reza

Middle East journal of digestive diseases

2019 Volume 11, Issue 2, Page(s) 90–97

Abstract: BACKGROUND Achalasia is the most well known esophageal motility disorder. Laparoscopic Heller myotomy (LHM) is the most effective treatment for achalasia. The aim of this study was to review our results on LHM for achalasia. METHODS In this cross- ... ...

Abstract	BACKGROUND Achalasia is the most well known esophageal motility disorder. Laparoscopic Heller myotomy (LHM) is the most effective treatment for achalasia. The aim of this study was to review our results on LHM for achalasia. METHODS In this cross-sectional study all patients undergoing LHM between 2015 and 2017 were studied. The myotomy was followed by an anterior or posterior partial fundoplication. All patients were followed up for at least six months. RESULTS We conducted this prospective study on 36 consecutive patients who underwent LHM over 3 years. The mean age of the patients was 36.64 ± 13.47 years. 30 patients (83.3%) underwent Toupet and 6 patients (16.7%) received Dor fundoplication. 11 patients (30.6%) developed reflux after the procedure. According to the Eckardt Symptom Scoring (ESS), the symptoms improved in 74.2% of the patients and remained unchanged in 25.8% of the patients. Analysis of the ESS, indicated a significant change in regurgitation and retrosternal pain, dysphagia, and weight loss after the surgery (
Language	English
Publishing date	2019-01-25
Publishing country	Iran
Document type	Journal Article
ZDB-ID	2623796-9
ISSN	2008-5249 ; 2008-5230
ISSN (online)	2008-5249
ISSN	2008-5230
DOI	10.15171/mejdd.2018.133
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Article: Is There Any Evidence for a Viral Cause in Achalasia?

Moradi, Abdolvahab / Fazlollahi, Narges / Eshraghi, Amid / Gholipour, Mahin / Khoshnia, Masoud / Javid, Naeme / Montazeri, Seyed Ali / Mikaeli, Javad

Middle East journal of digestive diseases

2018 Volume 10, Issue 3, Page(s) 169–173

Abstract: BACKGROUND Achalasia, as an incurable disease is defined by the lack of normal esophageal peristalsis and loss of lower esophageal sphincter relaxation due to impaired myenteric neural plexus. The exact cause of myenteric neural cells degeneration in ... ...

Abstract	BACKGROUND Achalasia, as an incurable disease is defined by the lack of normal esophageal peristalsis and loss of lower esophageal sphincter relaxation due to impaired myenteric neural plexus. The exact cause of myenteric neural cells degeneration in achalasia is still unknown. One hypothesis is that certain neurotropic viruses and autoimmune factors cause the inflammatory response in myenteric network, which consequently destroy neural cells. This study was designed to find the evidence of viral causes of achalasia. METHODS In this case-control study, 52 patients with achalasia and 50 controls referred to Shariati Hospital, were evaluated for the genome of neurotropic viruses, HPV, and adenovirus by polymerase chain reaction (PCR) and reverse transcription (RT) PCR techniques. RESULTS Genome assessment of neurotropic DNA viruses turned out negative in the patients, however, the genome of HSV-1 (Herpes simplex virus) was found in tissues of six controls. No neurotropic RNA viruses were observed in the tissue samples and whole blood of both the patients and controls. Among non-neurotropic viruses, adenovirus genome was positive in tissues of two out of 52 patients and three out of 50 controls. In addition, one out of 52 patients and two out of 50 controls were positive for HPV infection in tissues. CONCLUSION We could not detect any significant relationship between achalasia and HPV, adenovirus, and neurotropic viruses in the cases. Nevertheless, it does not exclude the hypothesis of either an alternate viral species or resolved viral infection as the etiology of achalasia.
Language	English
Publishing date	2018-06-23
Publishing country	Iran
Document type	Journal Article
ZDB-ID	2623796-9
ISSN	2008-5249 ; 2008-5230
ISSN (online)	2008-5249
ISSN	2008-5230
DOI	10.15171/mejdd.2018.106
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Laparoscopic Heller Myotomy for Achalasia

Alireza Mirsharifi / Ali Ghorbani Abdehgah / Rasoul Mirsharifi / Mehdi Jafari / Noor Fattah / Javad Mikaeli / Ahmad Reza Soroush

Middle East Journal of Digestive Diseases, Vol 11, Iss 2, Pp 90-

Experience from a Single Referral Tertiary Center

2019 Volume 97

Abstract	BACKGROUND Achalasia is the most well known esophageal motility disorder. Laparoscopic Heller myotomy (LHM) is the most effective treatment for achalasia. The aim of this study was to review our results on LHM for achalasia. METHODS In this cross-sectional study all patients undergoing LHM between 2015 and 2017 were studied. The myotomy was followed by an anterior or posterior partial fundoplication. All patients were followed up for at least six months. RESULTS We conducted this prospective study on 36 consecutive patients who underwent LHM over 3 years. The mean age of the patients was 36.64 ± 13.47 years. 30 patients (83.3%) underwent Toupet and 6 patients (16.7%) received Dor fundoplication. 11 patients (30.6%) developed reflux after the procedure. According to the Eckardt Symptom Scoring (ESS), the symptoms improved in 74.2% of the patients and remained unchanged in 25.8% of the patients. Analysis of the ESS, indicated a significant change in regurgitation and retrosternal pain, dysphagia, and weight loss after the surgery (p = 0.001, p = 0.002, p = 0.046, and p = 0.001, respectively). CONCLUSION LHM with anterior or posterior partial fundoplication is safe and achieves a good outcome in the treatment of achalasia, especially in patients who have not responded to other methods while no serious complication was reported despite several prior endoscopic interventions.
Keywords	Heller myotomy ; Achalasia ; Tertiary center ; Laparoscopy ; Botulinum toxin ; Medicine ; R
Subject code	616
Language	English
Publishing date	2019-04-01T00:00:00Z
Publisher	Iranian Association of Gastroenterology and Hepatology, Shiraz University of Medical Sciences
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Achalasia

Javad Mikaeli, Farhad Islami, Reza Malekzadeh

World Journal of Gastroenterology, Vol 15, Iss 40, Pp 5000-

A review of Western and Iranian experiences

2009 Volume 5009

Abstract: Achalasia is a primary motor disorder of the esophagus, in which esophageal emptying is impaired. Diagnosis of achalasia is based on clinical findings. The diagnosis is confirmed by radiographic, endoscopic, and manometric evaluations. Several treatments ...

Abstract	Achalasia is a primary motor disorder of the esophagus, in which esophageal emptying is impaired. Diagnosis of achalasia is based on clinical findings. The diagnosis is confirmed by radiographic, endoscopic, and manometric evaluations. Several treatments for achalasia have been introduced. We searched the PubMed Database for original articles and meta-analyses about achalasia to summarize the current knowledge regarding this disease, with particular focus on different procedures that are used for treatment of achalasia. We also report the Iranian experience of treatment of this disease, since it could be considered as a model for medium-resource countries. Myotomy, particularly laparoscopic myotomy with fundoplication, is the most effective treatment for achalasia. Compared to other treatments, however, the initial cost of myotomy is usually higher and the recovery period is longer. When performing myotomy is not indicated or not possible, graded pneumatic dilation with slow rate of balloon inflation seems to be an effective and safe initial alternative. Injection of botulinum toxin into the lower esophageal sphincter before pneumatic dilation may increase remission rates. However, this needs to be confirmed in further studies. Due to lack of adequate information regarding the role of expandable stents in the treatment of achalasia, insertion of stents does not currently seem to be a recommended treatment. In summary, laparoscopic myotomy can be considered as the procedure of choice for treatment of achalasia. Graded pneumatic dilation is an effective alternative when the performance of myotomy is not possible for any reason.
Keywords	Achalasia ; Esophagus ; Motility ; Treatment ; Diseases of the digestive system. Gastroenterology ; RC799-869 ; Specialties of internal medicine ; RC581-951 ; Internal medicine ; RC31-1245 ; Medicine ; R ; DOAJ:Gastroenterology ; DOAJ:Medicine (General) ; DOAJ:Health Sciences
Subject code	610
Language	English
Publishing date	2009-10-01T00:00:00Z
Publisher	Baishideng Publishing Group Co. Limited
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Is There Any Evidence for a Viral Cause in Achalasia?

Abdolvahab Moradi / Narges Fazlollahi / Amid Eshraghi / Mahin Gholipour / Masoud Khoshnia / Naeme Javid / Seyed Ali Montazeri / Javad Mikaeli

Middle East Journal of Digestive Diseases, Vol 10, Iss 3, Pp 169-

2018 Volume 173

Abstract	BACKGROUND Achalasia, as an incurable disease is defined by the lack of normal esophageal peristalsis and loss of lower esophageal sphincter relaxation due to impaired myenteric neural plexus. The exact cause of myenteric neural cells degeneration in achalasia is still unknown. One hypothesis is that certain neurotropic viruses and autoimmune factors cause the inflammatory response in myenteric network, which consequently destroy neural cells. This study was designed to find the evidence of viral causes of achalasia. METHODS In this case-control study, 52 patients with achalasia and 50 controls referred to Shariati Hospital, were evaluated for the genome of neurotropic viruses, HPV, and adenovirus by polymerase chain reaction (PCR) and reverse transcription (RT) PCR techniques. RESULTS Genome assessment of neurotropic DNA viruses turned out negative in the patients, however, the genome of HSV-1 (Herpes simplex virus) was found in tissues of six controls. No neurotropic RNA viruses were observed in the tissue samples and whole blood of both the patients and controls. Among non-neurotropic viruses, adenovirus genome was positive in tissues of two out of 52 patients and three out of 50 controls. In addition, one out of 52 patients and two out of 50 controls were positive for HPV infection in tissues. CONCLUSION We could not detect any significant relationship between achalasia and HPV, adenovirus, and neurotropic viruses in the cases. Nevertheless, it does not exclude the hypothesis of either an alternate viral species or resolved viral infection as the etiology of achalasia.
Keywords	Achalasia ; DNA neurotropic viruses ; RNA neurotropic viruses ; HPV ; Medicine ; R
Subject code	616
Language	English
Publishing date	2018-07-01T00:00:00Z
Publisher	Iranian Association of Gastroenterology and Hepatology, Shiraz University of Medical Sciences
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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