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Achalasia

 

Achalasia

Achalasia is an esophageal motility disorder in which there is difficulty in the passage of food as well as liquid to the stomach. Most common cause is degeneration of the neurons in the which make esophagus paralyzed and distended. This results in washing back of food into the mouth which sometimes be mistaken as GERD. However, in GERD the origin of material is from stomach.

SymptomsAchalasia
  • Dysphagia {difficulty in swallowing}
  • Dysphagia is both for solids and liquids
  • Blenching
  • Chest pain that comes and goes
  • Coughing at night
  • Pneumonia (from aspiration of food into the lungs)
  • Weight loss
  • Vomiting
Causes
  • Exact cause is poorly understood [idiopathic]
  • Degeneration of inhibitory neurons
  • Rarely due to genetic manifestation
  • Viral or autoimmune diseases
Diagnosis

 it can be tricky to diagnose achalasia due to its clinical features which are similar to other digestive disorders.

  • Esophageal manometry: this test detects about the type of motility problem. Its gives measurements about the rhythm, force and coordination of esophageal muscles when you swallow. This test also measures the lower esophageal sphincter tone.
  • X-rays of your upper digestive system (esophagram): After drinking chalky white liquid or swallowing a=barium pill x-ray of abdomen is taken which will help to see the silhouette of esophagus
  • Upper endoscopy: in this a thin flexible tube is passed down the throat to examine the inside of esophagus and small intestine either to see any possible blockage or for biopsy on complication of reflux like Barrett’s esophagus.
Treatment

There is not any proper cure of achalasia but it can be managed by various methods depending about age and severity of achalasia:

  • Non-surgical methods;
    • Pneumatic dilation. A balloon is placed by the help of endoscopy into the esophagus and then inflate inside to make the opining large. This requires anesthesia. About 1/3rd of patients treated by pneumatic dilation needs repeated treatment in five years.
    • Botox (botulinum toxin type A). For the people who are not suitable for balloon a muscle relaxant can be directly injected into the sphincter. As this treatment require repeated injections surgery become difficult in future if necessary.
    • Medication: Medications are not usually indicated. Muscle relaxants can be prescribed like nitroglycerin and nifedipine
Surgery
  • Heller myotomy. In this procedure surgeon cuts lower esophageal sphincter so that food can easily be passed to the stomach. This is done noninvasively [ laparoscopic hellers myotomy]. GERD can arise as a complication of this surgery. To overcome this fundoplication is done along with hellers myotomy in which stomach is wrap around the lower esophageal sphincter to word as anti-reflux valve.
  • Peroral endoscopic myotomy (POEM). In this procedure an incision is made inside the lining of esophagus with the help of endoscopy then cut open the muscle at lower sphincter same as in hellers myotomy.
 
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