[New trends and concepts in diagnosis and treatment of achalasia].

The last 2 decades have witnessed a revolution in the treatment of esophageal achalasia. Nowadays, laparoscopic Heller myotomy with partial fundoplication is considered in most centers the primary treatment modality, while endoscopic treatment, i.e. pneumatic dilatation, is mainly reserved for the management of patients unfit for surgery or in case of surgical failure. Recently, a new approach to achalasia has been proposed: the peroral endoscopic myotomy (POEM), which combines the advantages of endoscopy and surgery. This article reviews the evolution of the diagnosis and treatment of esophageal achalasia during the last 20 years.