A Controversy That Has Been Tough to Swallow: Is the Treatment of Achalasia Now Digested?

Esophageal achalasia is a rare neurodegenerative disease of the esophagus and the lower esophageal sphincter that presents within a spectrum of disease severity related to progressive pathological changes, most commonly resulting in dysphagia. The pathophysiology of achalasia is still incompletely understood, but recent evidence suggests that degeneration of the postganglionic inhibitory nerves of the myenteric plexus could be due to an infectious or autoimmune mechanism, and nitric oxide is the neurotransmitter affected. Current treatment of achalasia is directed at palliation of symptoms. Therapies include pharmacological therapy, endoscopic injection of botulinum toxin, endoscopic dilation, and surgery. Until the late 1980s, endoscopic dilation was the first line of therapy. The advent of safe and effective minimally invasive surgical techniques in the early 1990s paved the way for the introduction of laparoscopic myotomy. This review will discuss the most up-to-date information regarding the pathophysiology, diagnosis, and treatment of achalasia, including a historical perspective. The laparoscopic Heller myotomy with partial fundoplication performed at an experienced center is currently the first line of therapy because it offers a low complication rate, the most durable symptom relief, and the lowest incidence of postoperative gastroesophageal reflux

New records of rare species in the Mediterranean Sea (May 2022)

This Collective Article presents new information about the occurrence of 21 taxa that belong to six Phyla: one Cnidaria, one Ctenophora, two Annelida, four Mollusca, two Arthropoda, and eleven Chordata. These records were reported from ten countries from the western to the eastern Mediterranean Sea as follows: Spain: early colonization signs of the Mar Menor lagoon by the cigar jellyfish Olindias muelleri; France: second record of the sea chub of the genus Kyphosus in French Mediterranean waters; Italy: first record of the marbled crab Pachygrapsus maurus in Sardinian waters; first records of the polychaetes Malmgrenia polypapillata and Levinsenia tribranchiata in the Tyrrhenian Sea; new record of the deep-sea squid Ancistrocheirus lesueurii in the Tyrrhenian Sea; first record of the pignosed arrowtooth eel Dysomma brevirostre in the Adriatic Sea; Tunisia: first documented record of the blue butterfish Stromateus fiatola and new record of the iconic great white shark Carcharodon carcharias in the Gulf of Gabes; Slovenia: first records of the sea slug Diaphorodoris alba and the sharpnose sevengill shark Heptranchias perlo; Montenegro: new record of the rare tope shark Galeorhinus galeus; Greece: new records of the rabbitfish Chimaera monstrosa and the electric ray Tetronarce nobiliana; first published record of the nuribranch Discodoris rosi; first record of the goblin shark Mitsukurina owstoni, unreported so far from the entire Mediterranean; Turkey: first record of the ctenophore Hormiphora plumosa at country level; first records of the anomuran decapod Munida speciosa and the Mediterranean tripodfish, Bathypterois mediterraneus from the Levantine Sea; Cyprus: first documented record of the nuribranch Scyllaea pelagica; Lebanon: first record of the killer whale Orcinus orca from the Levantine Sea