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Achalasia
Esophageal achalasia, also called simply achalasia, is a neuromuscular
disorder of the esophagus characterized by the reduced ability to move
food down the esophagus (peristalsis). In addition, the inability of the
cardia ( also called lower esophageal sphincter)- to relax in response
to swallowing (there is increased LES pressure- spasms).
Signs and symptoms
- Dysphagia
- Regurgitation of digested food
- Heartburn
- Chest pains : increases after eating and may radiate to the back, neck,
and arms.
- Weight loss
- Coughing, especially at night or when lying down
Diagnosis
Due to the similarity of symptoms, achalasia can be misdiagnosed as
other disorders, such as gastroesophageal reflux disease (GERD) and
Chagas disease.
X-ray with a barium swallow or esophagography . Shows narrowing at the
level of the gastroesophageal junction ("bird beak"), and various
degrees of megaesophagus (esophageal dilation).
Endoscopy, which provides a view from within the esophagus.
Manometry, the key test for establishing the diagnosis. Measures the
pressure induced in different parts of the esophagus and stomach during
the act of swallowing.
CT scan, which provides further visual evidence.
Complications
Gastroesophageal reflux disease-GERD or heartburn.
Barrett's esophagus or Barrett's mucosa: in 10% of patients.
There are two kinds of esophageal cancer: squamous cell carcinoma and
adenocarcinoma. There are predisposing conditions that, if present for a
long time, may lead to esophageal adenocarcinoma, like achalasia (in up
to 5% of cases, Barrett's esophagus leads to esophageal adenocarcinoma).
Treatment
Balloon (pneumatic) dilation. The muscle fibers will be stretched.
Gastroesophageal reflux (GERD) occurs after dilatation in 25% to 35% of
patients. Is a risk to later
Heller myotomy.
Intra-sphincteric injection of botulinum toxin (or botox), to paralyze
cardia and prevent spasms. It is transitory and symptoms will return in
the majority of patients within a year.
Drugs that reduce LES pressure such as nifedipine and nitroglycerin may
be useful.
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