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Fulltext Immunochromatographic test for rapid serological diagnosis of human angiostrongyliasis

Eamsobhana P, Tungtrongchitr A, Wanachiwanawin D, Yong HS

Int J Infect Dis, 2018 Aug;73:69-71.
PMID: 29908250 DOI: 10.1016/j.ijid.2018.06.005

OBJECTIVES: The serological diagnosis of human infection with Angiostrongylus cantonensis remains problematic because there are no commercially available validated tests. Most laboratories use domestically prepared tests such as the enzyme-linked immunosorbent assay (ELISA) or immunoblotting. Since laboratory facilities are not always available in endemic areas, we developed and assessed a rapid lateral flow immunochromatographic assay (AcQuickDx Test) to detect anti-A. cantonensis antibodies in human serum.
METHODS: The test device was assembled with purified 31-kDa glycoprotein as diagnostic antigen and with gold-labelled anti-human immunoglublin-G as the detector reagent. A total of 97 serum samples were tested - 19 samples from clinically diagnosed patients with detectable A. cantonensis-specific antibody in immunoblotting; 43 samples from patients with other parasitic diseases, i.e. gnathostomiasis (n=13), toxocariasis (n=2), trichinellosis (n=2), hookworm infection (n=4), filariasis (n=5), cysticercosis (n=9), paragonimiasis (n=2), opisthorchiasis (n=3), and malaria (n=3); and 35 samples from normal healthy subjects.
RESULTS: The sensitivity, specificity, positive predictive value and negative predictive value of AcQuickDx Test to detect anti-A. cantonensis specific antibodies in serologically confirmed angiostrongyliasis cases, were 100%, 98.72%, 95% and 100%, respectively. Positive AcQuickDx was observed in 1 of 4 cases with hookworm infections. No positive AcQuickDx was observed in cases with other parasitic diseases, and the individual healthy subjects.
CONCLUSIONS: AcQuickDx Test is rapid, highly sensitive and specific, and easy to perform without additional equipment or ancillary supplies. It yields results that are interpreted visually, and possesses a long shelf-life at room temperature. Thus, it can be applied as an additional test for clinical diagnostic support of angiostrongyliasis either in conventional laboratories or for remote areas where laboratory infrastructure is not available.

Matched MeSH terms: Strongylida Infections/diagnosis*
Assessment of Visual Acuity in Children Using Crowded Lea Symbol Charts

Sailoganathan A, Rou LX, Buja KA, Siderov J

Optom Vis Sci, 2018 08;95(8):643-647.
PMID: 30063661 DOI: 10.1097/OPX.0000000000001253

SIGNIFICANCE: Vision charts comprising single Lea symbols surrounded by either flanking bars or flanking Lea symbols are available for measurement of visual acuity in children. However, the results obtained with such charts may not be interchangeable owing to potential differences in the crowding effect.
PURPOSE: The purpose of this study was to compare habitual visual acuity in a sample of young children using two versions of the single Lea symbols charts with different crowding features.
METHODS: Monocular habitual visual acuity was measured in a sample of 77 young children aged between 4 and 6 years using crowded Lea symbols charts with either flanking bars separated from the central symbol by 0.5 optotype width or flanking Lea optotypes separated from the central symbol by 1.0 optotype width.
RESULTS: Mean visual acuity was higher (i.e., lower logarithm of the minimum angle of resolution) with the Lea symbols crowded using flanking optotypes, equivalent to about 1.5 optotype difference. Visual acuity measured with the two charts was significantly correlated; however, the 95% limits of agreement were larger than expected from repeatability studies using Lea symbols.
CONCLUSIONS: Lea symbols with flanking optotypes resulted in higher visual acuity than the Lea symbols with flanking bars, probably as a result of differences in the crowding effect. The two charts showed insufficient agreement, and we do not recommend their use interchangeably. We recommend using the Lea symbols with flanking bars because of the closer flanker-target separation.

Matched MeSH terms: Vision Disorders/diagnosis
The Effects of Telemedicine on Asthma Control and Patients' Quality of Life in Adults: A Systematic Review and Meta-analysis

Chongmelaxme B, Lee S, Dhippayom T, Saokaew S, Chaiyakunapruk N, Dilokthornsakul P

J Allergy Clin Immunol Pract, 2019 01;7(1):199-216.e11.
PMID: 30055283 DOI: 10.1016/j.jaip.2018.07.015

BACKGROUND: Telemedicine is increasingly used to improve health outcomes in asthma. However, it is still inconclusive which telemedicine works effectively.
OBJECTIVE: This study aimed to determine the effects of telemedicine on asthma control and the quality of life in adults.
METHODS: An electronic search was performed from the inception to March 2018 on the following databases: Cochrane CENTRAL, CINAHL, ClinicalTrials.gov, EMBASE, PubMed, and Scopus. Randomized controlled trials that assessed the effects of telemedicine in adults with asthma were included in this analysis, and the outcomes of interest were levels of asthma control and quality of life. Random-effects model meta-analyses were performed.
RESULTS: A total of 22 studies (10,281 participants) were included. Each of 11 studies investigated the effects of single-telemedicine and combined-telemedicine (combinations of telemedicine approaches), and the meta-analyses showed that combined tele-case management could significantly improve asthma control compared with usual care (standardized mean difference [SMD] = 0.78; 95% confidence interval [CI]: 0.56, 1.01). Combined tele-case management and tele-consultation (SMD = 0.52 [95% CI: 0.13, 0.91]) and combined tele-consultation (SMD = 0.28 [95% CI: 0.13, 0.44]) also significantly improved asthma outcomes, but to a lesser degree. In addition, combined tele-case management (SMD = 0.59 [95% CI: 0.31, 0.88]) was the most effective telemedicine for improving quality of life, followed by combined tele-case management and tele-consultation (SMD = 0.31 [95% CI: 0.03, 0.59]), tele-case management (SMD = 0.30 [95% CI: 0.05, 0.55]), and combined tele-consultation (SMD = 0.27 [95% CI: 0.11, 0.43]), respectively.
CONCLUSIONS: Combined-telemedicine involving tele-case management or tele-consultation appear to be effective telemedicine interventions to improve asthma control and quality of life in adults. Our findings are expected to provide health care professionals with current evidence of the effects of telemedicine on asthma control and patients' quality of life.

Matched MeSH terms: Asthma/diagnosis*
Fulltext Opsoclonus

Amin OS, Shwani SS

BMJ Case Rep, 2017 Feb 15;2017.
PMID: 28202488 DOI: 10.1136/bcr-2017-219433
Matched MeSH terms: Ocular Motility Disorders/diagnosis
Incomplete Kawasaki Disease in a 44-day-old baby

Nor Azizah A, Thong SP, Hung LC

Med J Malaysia, 2018 08;73(4):257-259.
PMID: 30121692 MyJurnal

Kawasaki disease (KD) is an acute systemic vasculitis usually affecting children <5 years old. We report a 44-dayold baby who had persistent fever despite being on antibiotics for presumed sepsis. Erythema of Bacillus Calmette-Guerin (BCG) scar and thrombocytosis were noted on day-2 of illness. Diagnosis of incomplete KD was made on the 10th day of illness. Her fever resolved with intravenous immunoglobulin, but echocardiogram revealed coronary artery aneurysm. High index of suspicion is required to diagnose KD in infants ≤3 months since it is rare and commonly presents with incomplete clinical features. The presence of unexplained fever for ≥5 days with erythema of BCG scar or thrombocytosis in infants should alert the clinicians of KD.

Matched MeSH terms: Mucocutaneous Lymph Node Syndrome/diagnosis*
Seasonal influenza activity based on laboratory surveillance in Malaysia, 2011-2016

Sam IC, Noraini W, Sandhu SS, Norizah I, Selvanesan S, Thayan R, et al.

J Med Virol, 2019 03;91(3):498-502.
PMID: 30199092 DOI: 10.1002/jmv.25313

Influenza seasonality in equatorial countries is little understood. Seasonal and alert influenza thresholds were determined for Malaysia, using laboratory-based data obtained from the Malaysia Influenza Surveillance System and a major teaching hospital, from 2011 to 2016. Influenza was present year-round, with no clear annual seasons. Variable periods of higher transmission occurred inconsistently, in November to December, January to March, July to September, or a combination of these. These coincide with seasons in the nearby southeast Asian countries or winter seasons of the northern and southern hemispheres. Changes in the predominant circulating influenza type were only sometimes associated with increased transmission. The data can provide public health interventions such as vaccines.

Matched MeSH terms: Influenza, Human/diagnosis*
Fulltext Potential Point-of-Care Microfluidic Devices to Diagnose Iron Deficiency Anemia

Yap BK, M Soair SN, Talik NA, Lim WF, Mei I L

Sensors (Basel), 2018 Aug 10;18(8).
PMID: 30103424 DOI: 10.3390/s18082625

Over the past 20 years, rapid technological advancement in the field of microfluidics has produced a wide array of microfluidic point-of-care (POC) diagnostic devices for the healthcare industry. However, potential microfluidic applications in the field of nutrition, specifically to diagnose iron deficiency anemia (IDA) detection, remain scarce. Iron deficiency anemia is the most common form of anemia, which affects billions of people globally, especially the elderly, women, and children. This review comprehensively analyzes the current diagnosis technologies that address anemia-related IDA-POC microfluidic devices in the future. This review briefly highlights various microfluidics devices that have the potential to detect IDA and discusses some commercially available devices for blood plasma separation mechanisms. Reagent deposition and integration into microfluidic devices are also explored. Finally, we discuss the challenges of insights into potential portable microfluidic systems, especially for remote IDA detection.

Matched MeSH terms: Anemia, Iron-Deficiency/diagnosis*
[Laboratory diagnosis and molecular tracing of dengue bordline cases in Henan Province, 2017]

Du YH, Li Y, Wang RL, Wang HF, Su J, Xu BL, et al.

Zhonghua Yu Fang Yi Xue Za Zhi, 2018 Nov 06;52(11):1164-1167.
PMID: 30419702 DOI: 10.3760/cma.j.issn.0253-9624.2018.11.013

Objective: To confirm the laboratory diagnosis of dengue bordline cases reported in Henan Province and trace its origin from molecular level in 2017. Methods: The study samples were blood samples (3-5 ml), which came from 8 suspected cases of dengue fever reported in the 2017 direct reporting system of Henan provincial infectious disease monitoring network. Meanwhile, case investigation was conducted according to National dengue fever surveillance programme. Serum were separated from blood samples and tested for Dengue NS1 antigen, IgM & IgG antibodies, and dengue RNA. According to dengue diagnosis criteria, confirmed cases were identified by testing results. Samples carried dengue RNA performed for real-time PCR genotyping and amplification of E gene. Then, the amplicons were sequenced and homological and phylogenetic analyses were constructed. Results: 8 serum samples of suspected dengue cases were collected in Henan Province, 2017. Six of them were diagnosed as dengue confirmed cases. All the dengue confirmed cases belonged to outside imported cases, 5 of them were positive by dengue RNA testing. Genotyping results showed there were 1 DENV1 case, 2 DENV2 cases and 2 DENV3 cases. A DENV2 case and a DENV3 case of this study were traced its origin successfully. The sequence of Pakistan imported DENV2 case belongs to cosmopolitan genotype, which was the most consistent with Pakistan's DENV2 KJ010186 in 2013 (identity 99.0%). The sequence of Malaysia imported DENV3 case belongs to genotype I, which was the most consistent with Singapore's DENV3 KX224276 in 2014(identity 99.0%). Conclusion: The laboratory diagnosis and molecular traceability of dengue cases in Henan Province in 2017 confirmed that all cases were imported and did not cause local epidemics.

Matched MeSH terms: Dengue/diagnosis*
Atypical Presentation of Pyogenic Granuloma of the Right Index Finger: A Rare Case Report

Tan LS, Daud MH, Nasirudin N

J Hand Surg Asian Pac Vol, 2018 Dec;23(4):577-580.
PMID: 30428790 DOI: 10.1142/S2424835518720335

Pyogenic granuloma, also known as lobular capillary hemangioma, is a benign vascular lesion of the skin or mucous membrane with rapid growth or repetitive trauma. Rarely seen in adult, its management varies and surgical intervention is usually common. We report a case of pyogenic granuloma of the right index finger in a 46-year-old gentleman who presented with painless swelling of the right index finger after a trivial injury. Wedge biopsy confirmed the diagnosis and excision of the granuloma measuring 3 cm × 3 cm × 2 cm was done with curettage and electrocautery over the base of granuloma. The wound subsequently healed well with good functional and aesthetic outcome.

Matched MeSH terms: Granuloma, Pyogenic/diagnosis*
Erythematous verrucous plaque on the hand

Yee EY, Choon SE

Cutis, 2018 Oct;102(4):223;230;231.
PMID: 30489556
Matched MeSH terms: Agricultural Workers' Diseases/diagnosis*; Carcinoma, Squamous Cell/diagnosis; Chromoblastomycosis/diagnosis*; Diagnosis, Differential; Hand Dermatoses/diagnosis*; Neoplasm Recurrence, Local/diagnosis; Skin Neoplasms/diagnosis
Schistosomiasis in Malaysia: A review

Chuah C, Gobert GN, Latif B, Heo CC, Leow CY

Acta Trop, 2019 Feb;190:137-143.
PMID: 30448471 DOI: 10.1016/j.actatropica.2018.11.012

Schistosomiasis, a neglected tropical parasitic disease caused by the trematode flatworms of the genus Schistosoma, affects approximately 207 million people worldwide. Among the five main species infecting humans, Schistosoma mansoni and S. japonicum are responsible for the majority of hepatointestinal schistosomiasis. Human settlements near fresh water sites that lack proper sanitary systems often contribute to the transmission of disease. This risk particularly impacts on travellers or immigrants who come into contact with larvae-contaminated water. This review discusses the central features of schistosomiasis; including clinical manifestations, diagnosis, treatments, and the preventive measures available for the control of this disease. The description of the Malaysian schistosome species Schistosoma malayensis and the current status of schistosomiasis in Malaysia including the compilation of cases diagnosed from 1904 to 2015 are also discussed in this paper.

Matched MeSH terms: Schistosomiasis/diagnosis
Automated Depression Detection Using Deep Representation and Sequence Learning with EEG Signals

Ay B, Yildirim O, Talo M, Baloglu UB, Aydin G, Puthankattil SD, et al.

J Med Syst, 2019 May 28;43(7):205.
PMID: 31139932 DOI: 10.1007/s10916-019-1345-y

Depression affects large number of people across the world today and it is considered as the global problem. It is a mood disorder which can be detected using electroencephalogram (EEG) signals. The manual detection of depression by analyzing the EEG signals requires lot of experience, tedious and time consuming. Hence, a fully automated depression diagnosis system developed using EEG signals will help the clinicians. Therefore, we propose a deep hybrid model developed using convolutional neural network (CNN) and long-short term memory (LSTM) architectures to detect depression using EEG signals. In the deep model, temporal properties of the signals are learned with CNN layers and the sequence learning process is provided through the LSTM layers. In this work, we have used EEG signals obtained from left and right hemispheres of the brain. Our work has provided 99.12% and 97.66% classification accuracies for the right and left hemisphere EEG signals respectively. Hence, we can conclude that the developed CNN-LSTM model is accurate and fast in detecting the depression using EEG signals. It can be employed in psychiatry wards of the hospitals to detect the depression using EEG signals accurately and thus aid the psychiatrists.

Matched MeSH terms: Depression/diagnosis*
Fulltext National income, self-reported wheezing and asthma diagnosis from the World Health Survey

Sembajwe G, Cifuentes M, Tak SW, Kriebel D, Gore R, Punnett L

Eur Respir J, 2010 Feb;35(2):279-86.
PMID: 19741032 DOI: 10.1183/09031936.00027509

The aims of this study were to quantify and describe the variations in respiratory symptoms and diagnosis prevalence across regions of the world according to national income. In 2002 and 2003, the World Health Organization implemented the World Health Survey (WHS), which used a standardised survey instrument to compile comprehensive baseline information on health and healthcare expenditure. We analysed the WHS data to assess the global patterns of self-reported wheeze and doctor-diagnosed asthma, two commonly reported measures of respiratory health. In total there were 308,218 participants with complete records, from 64 countries. The weighted mean age of the survey population was 43 yrs. Global prevalence of current wheezing symptoms ranged from 2.4% in Vietnam to 24% in Brazil; the prevalence of diagnosed asthma ranged from 1.8% in Vietnam to 32.8% in Australia. Overall, the prevalence of symptoms and diagnosis showed a U-shaped pattern with the largest prevalence reported in low- and high-income countries. The smallest prevalence was consistently found in middle-income countries. These WHS analyses have provided global prevalence estimates of wheeze and doctor-diagnosed asthma using data gathered simultaneously and consistently across six continents. These findings support the need for continued global respiratory illness surveillance for disease prevention, health policy and management.
Study name: World Health Survey (Malaysia is a study site)

Matched MeSH terms: Asthma/diagnosis*
Gianotti-Crosti syndrome (papular acrodermatitis of childhood) in the era of a viral recrudescence and vaccine opposition

Leung AKC, Sergi CM, Lam JM, Leong KF

World J Pediatr, 2019 Dec;15(6):521-527.
PMID: 31134587 DOI: 10.1007/s12519-019-00269-9

BACKGROUND: Gianotti-Crosti syndrome is characterized by an acute onset of a papular or papulovesicular eruption with a symmetrical distribution.
DATA SOURCES: A PubMed search was conducted using Clinical Queries with the key terms "Gianotti-Crosti syndrome" OR "papular acrodermatitis". The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews. This paper is based on, but not limited to, the search results.
RESULTS: The eruption of Gianotti-Crosti syndrome is found predominantly on the cheeks, extensor surfaces of the extremities, and buttocks. There is a sparing of antecubital and popliteal fossae as well as palms, soles, and mucosal surfaces. Although often asymptomatic, the lesions may be mildly to moderately pruritic. Gianotti-Crosti syndrome is most common in children between 1 and 6 years of age. The Epstein-Barr virus and the hepatitis B virus are the most common pathogens associated with Gianotti-Crosti syndrome. No treatment for Gianotti-Crosti syndrome is necessary because it is self-limited. In an era of vaccine hesitancy and refusal, Gianotti-Crosti syndrome may be important to mention to parents, because it can occur and trigger alarmism.
CONCLUSIONS: Gianotti-Crosti syndrome is mainly a disease of early childhood, characterized by an acute onset of a papular or papulovesicular eruption with a symmetrical distribution. With the advent of more universal vaccination against hepatitis B virus, Epstein-Barr virus has become the most common etiologic agent of Gianotti-Crosti syndrome. Few cases of post-vaccination Gianotti-Crosti syndrome have been reported. Currently, the emphasis should be placed on its self-limiting attribution.

Matched MeSH terms: Acrodermatitis/diagnosis
Coronoid hyperplasia: A review

Goh YC, Tan CC, Lim D

J Stomatol Oral Maxillofac Surg, 2020 Sep;121(4):397-403.
PMID: 31904534 DOI: 10.1016/j.jormas.2019.12.019

Coronoid hyperplasia is one of the rare causes of progressive limitation of mouth opening due to impingement of the enlarged coronoid process of the mandible on the zygomatic bone. A review was performed on all cases reports and case series on coronoid hyperplasia. Gender, age at treatment, age of onset, types of hyperplasia (unilateral/bilateral), associated history, treatment, surgical approach, preoperative mouth opening, intraoperative mouth opening, mouth opening at follow up and follow up period were recorded and analyzed. A total of 82 articles which reported 115 cases were included. Coronoid hyperplasia was commonly reported at mean age of 22.64 years old with male preponderance. Most of the cases were diagnosed and treated between the age of 11-20 years old. This condition commonly involved bilateral coronoid process of mandible. The mean width of preoperative mouth opening was 16.5mm and was improved to a mean mouth opening of 36.3mm intraoperatively. Mean mouth opening was 34.8mm at an average follow up of 19 months. While the etiopathogenesis of coronoid hyperplasia is still not conclusive, treatment with either coronoidectomy or coronoidotomy produced good improvement in mouth opening.

Matched MeSH terms: Hyperplasia/diagnosis
Clinical recognition of elder maltreatment and intention to report among primary care doctors

Mohd Mydin FH, Othman S, Choo WY, Hairi NNM, Hairi FM, Syed Karim SN, et al.

J Elder Abuse Negl, 2020 02 21;32(1):72-83.
PMID: 32085693 DOI: 10.1080/08946566.2020.1731640

This study aimed to determine the primary care doctors' ability to recognize elder maltreatment and their intentions to report on such conditions. About 358 primary care doctors participated in this study. Outcomes were assessed using a validated five context-relevant clinical vignettes. Primary care doctor's recognition of sexual abuse was highest (91.0%); while the lowest (70.2%) in case signifying physical abuse. Despite being able to ascertain elder maltreatment, the intention to report the event is generally low even for cases exemplifying physical abuse, emotional abuse and neglect. However, intentions to report cases of sexual and financial abuse are 86.9% and 73.5% respectively. Findings highlighted the uncertainties of primary care doctors in distinguishing the clinical findings of non-accidental injuries and injuries due to acts of maltreatment. This provides support for educational intervention and guidelines or policies to improve the knowledge and skills of primary care doctors to intervene in elder maltreatment.

Matched MeSH terms: Elder Abuse/diagnosis*
Fulltext Isolation of Janthinobacterium lividum from early onset neonatal sepsis patients in Malaysia

Shinkafi SH, Umar S, Neela VK, Noordin SM, Noordin SA, Hudu SA, et al.

Afr Health Sci, 2019 Sep;19(3):2378-2389.
PMID: 32127808 DOI: 10.4314/ahs.v19i3.11

Background: The term early onset neonatal septicaemia (EONS) refers to invasive bacterial infections that primarily involve the blood stream of neonates during the first 3 days of life. Although early onset neonatal septicaemia is relatively uncommon, it may be associated with case fatality rates of 15-30% and substantial morbidity in surviving infants.
Objectives: This study describes an unusual septicaemia cases with Janthinobacterium lividum in neonatal Intensive Care Units.
Methods: Bacterial causes of early onset neonatal sepsis in Kuala Lumpur Hospital Malaysia were investigated using broad range 16S rDNA PCR and sequencing. The bacterial DNA was isolated directly from blood without pre-incubation. All samples collected were equally cultured and incubated in automated BACTEC system.
Results: Two hundred and fifty two neonates were recruited in this study with mean (SD) gestational age of 35.9. Neonates with J. lividum infection lacked microbiological evidence of septicaemia as their blood culture yielded no bacterial growth. However, the PCR analysis of these samples yielded 1100bp corresponding to bacteria species.
Conclusion: This study demonstrates the value of PCR in detecting bacteria where special growth requirement is involved.

Matched MeSH terms: Neonatal Sepsis/diagnosis*
Fulltext Non-infarcted myocardium bears the weight in CVD

Zhou H, Zainal H, Puntmann VO

Aging (Albany NY), 2019 03 25;11(6):1609-1610.
PMID: 30908271 DOI: 10.18632/aging.101890
Matched MeSH terms: Cardiovascular Diseases/diagnosis*
Lafora disease in a Malaysian with a rare mutation in the EPM2A gene

Tee SK, Ong TL, Aris A, See SML, Leong HY, Khalid MKNM, et al.

Seizure, 2019 Apr;67:78-81.
PMID: 30947044 DOI: 10.1016/j.seizure.2019.03.012
Matched MeSH terms: Lafora Disease/diagnosis*
Fulltext Bridging the gap between advancements in the evolution of diagnosis and treatment towards better outcomes in achalasia

Chuah SK, Lim CS, Liang CM, Lu HI, Wu KL, Changchien CS, et al.

Biomed Res Int, 2019;2019:8549187.
PMID: 30881999 DOI: 10.1155/2019/8549187

Over the past few decades, there was an encouraging breakthrough in bridging the gap between advancements in the evolution of diagnosis and treatment towards a better outcome in achalasia. The purpose of this review is to provide updated knowledge on how the current evidence has bridged the gap between advancements in the evolution of diagnosis and treatment of esophageal achalasia. The advent of high-resolution manometry and standardization based on the Chicago classification has increased early recognition of the disease. These 3 clinical subtypes of achalasia can predict the outcomes of patients, and the introduction of POEM has revolutionized the choice of treatment. Previous evidence has shown that laparoscopic Heller myotomy (LHM) and anterior fundoplication were considered the most durable treatments for achalasia. Based on the current evidence, POEM has been evolving as a promising strategy and is effective against all 3 types of achalasia, but the efficacy of POEM is based on short- and medium-term outcome studies from a limited number of centers. Types I and II achalasia respond well to POEM, LHM, and PD, while most studies have shown that type III achalasia responds better to POEM than to LHM and PD. In general, among the 3 subtypes of achalasia, type II achalasia has the most favorable outcomes after medical or surgical therapies. The long-term efficacy of POEM is still unknown. The novel ENDOFLIP measures the changes in intraoperative esophagogastric junction dispensability, which enables a quantitative assessment of luminal patency and sphincter distension; however, this technology is in its infancy with little data to date supporting its intraoperative use. In the future, identifying immunomodulatory drugs and the advent of stem cell therapeutic treatments, including theoretically transplanting neuronal stem cells, may achieve a functional cure. In summary, it is important to identify the clinical subtype of achalasia to initiate target therapy for these patients.

Matched MeSH terms: Esophageal Achalasia/diagnosis*

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