Harnessing Repurposed Drugs to Enhance Temozolomide Efficacy in Glioblastoma.

Achalasia cardia (AC) or idiopathic megaesophagus is a rare primary esophageal motility disorder characterized by impaired relaxation of the lower esophageal sphincter and the absence of coordinated peristalsis in the esophageal body, leading to progressive dysphagia, regurgitation, and weight loss []. Its global incidence is estimated at 1–5 cases per 100,000 population annually, with no sex predominance but an increasing frequency with age []. The condition is chronic and progressive, often diagnosed late in low- and middle-income countries (LMICs), where access to high-resolution manometry and specialized surgical expertise remains limited []. The therapeutic goal in AC is to relieve functional obstruction at the gastroesophageal junction. Multiple treatment modalities exist, including pneumatic dilation, botulinum toxin injection, peroral endoscopic myotomy (POEM), and surgical myotomy [, ]. Laparoscopic Heller myotomy (LHM) with partial fundoplication is considered the gold-standard surgical approach in many high-income countries, given its durable symptom relief and the ability to combine myotomy with an anti-reflux procedure [, ]. In LMICs, open surgery is still considered as the first-line definitive treatment []. Only a limited number of studies from Africa, mainly case reports and small case series, have addressed the surgical management of achalasia []. The majority of these describe open Heller myotomy performed through laparotomy, while reports of laparoscopic approaches remain relatively uncommon []. As a result, evidence regarding long-term functional outcomes, postoperative reflux control, and predictors of surgical failure in African populations is still very limited [].