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Background <p>Achalasia is a rare esophageal motility disorder. Globally, the diagnostic gold standard is high-resolution manometry (HRM), while management relies on minimally invasive therapy. However, the African evidence is fragmented and limited by system-level constraints. This scoping review maps the management of achalasia in Africa, focusing on diagnostic pathways, treatment modalities, outcomes, barriers, and suggestions to improve care.</p> Methods <p>A comprehensive search was conducted across databases, including PubMed, Scopus, Web of Science, African Journals Online (AJOL), African Index Medicus, and grey literature, for studies published in the last 10 years. We sought to identify diagnostic methods, management approaches, and patient outcomes via the eligible studies. Data were synthesized thematically.</p> Results <p>Seventeen studies from seven countries (<i>n</i> = 1,354) that satisfied the inclusion criteria were identified. North Africa contributed most of the data; diagnosis was largely based on endoscopy and barium swallow, and high-resolution manometry (HRM) was limited to a few tertiary centers. Across the treatment modalities, open and modified Heller’s myotomy, laparoscopic Heller’s myotomy (LHM), peroral endoscopic myotomy (POEM), and a combination of endoscopic techniques, symptom relief ranged between 87 and 100%, the perioperative mortality rate was &lt; 1%, with no postoperative mortality. However, up to 30% of patients experienced postoperative gastroesophageal reflux, and 9–17% experienced recurring symptoms requiring re-intervention. Barriers included outdated diagnostic methods, a shortage of trained personnel, high out-of-pocket (OOP) costs, and limited minimally invasive capacity, especially in sub-Saharan Africa.</p> Conclusion <p>Inadequate diagnostic capacity, reliance on open surgical methods, financial burden, and geographic inequities contribute to suboptimal care for achalasia. Prioritizing HRM-equipped centers, training skilled personnel, encouraging minimally invasive approaches, and ensuring strategic government investment and/or sustainable funding may help enhance achalasia care in Africa.</p>

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Achalasia Management in Africa: A Scoping Review of Treatment Outcomes, Challenges, and Strategies for Enhancing Care

  • 期刊论文

  • 发表日期：

    2026年7月14日

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  • Chidera Stanley Anthony,
  • Nwamaka Chidera Bob-Ume,
  • Alexander Idu Entonu,
  • Chukwudumebi Onyedikachukwu Egbuniwe,
  • Victor Oluwatomiwa Ajekiigbe,
  • Motunrayo Okunola,
  • Hawau Funmilola Anjorin,
  • Kenechukwu Clinton Agudosi,
  • Habiblah Ayomide Jagunmolu,
  • Thomas Oluwafiponmile Oyediran,
  • Olufemi Akinmeji,
  • Marvellous Inioluwa Adepoju,
  • Charity Onetemizeh Ayoson,
  • Aiken Muratova,
  • Ikponmwosa Jude Ogieuhi

摘要

Background

Achalasia is a rare esophageal motility disorder. Globally, the diagnostic gold standard is high-resolution manometry (HRM), while management relies on minimally invasive therapy. However, the African evidence is fragmented and limited by system-level constraints. This scoping review maps the management of achalasia in Africa, focusing on diagnostic pathways, treatment modalities, outcomes, barriers, and suggestions to improve care.

Methods

A comprehensive search was conducted across databases, including PubMed, Scopus, Web of Science, African Journals Online (AJOL), African Index Medicus, and grey literature, for studies published in the last 10 years. We sought to identify diagnostic methods, management approaches, and patient outcomes via the eligible studies. Data were synthesized thematically.

Results

Seventeen studies from seven countries (n = 1,354) that satisfied the inclusion criteria were identified. North Africa contributed most of the data; diagnosis was largely based on endoscopy and barium swallow, and high-resolution manometry (HRM) was limited to a few tertiary centers. Across the treatment modalities, open and modified Heller’s myotomy, laparoscopic Heller’s myotomy (LHM), peroral endoscopic myotomy (POEM), and a combination of endoscopic techniques, symptom relief ranged between 87 and 100%, the perioperative mortality rate was < 1%, with no postoperative mortality. However, up to 30% of patients experienced postoperative gastroesophageal reflux, and 9–17% experienced recurring symptoms requiring re-intervention. Barriers included outdated diagnostic methods, a shortage of trained personnel, high out-of-pocket (OOP) costs, and limited minimally invasive capacity, especially in sub-Saharan Africa.

Conclusion

Inadequate diagnostic capacity, reliance on open surgical methods, financial burden, and geographic inequities contribute to suboptimal care for achalasia. Prioritizing HRM-equipped centers, training skilled personnel, encouraging minimally invasive approaches, and ensuring strategic government investment and/or sustainable funding may help enhance achalasia care in Africa.