Achalasia

Other Name : Esophageal achalasia

Definition:
Achalasia is a disorder of the tube that carries food from the mouth to the stomach (esophagus), which affects the ability of the esophagus to move food toward the stomach.

 

Click to see Achalasia Image

 

At first it may only cause a minor problem, and often goes unnoticed. However, over time someone with achalasia finds it increasingly difficult to swallow food and liquid.

This is because the muscles in the oesophagus (gullet) which move foods and liquids into the stomach stop working properly. This leads to the oesophagus dilating, or stretching, which may lead to choking or coughing fits at night, triggered by food or liquids being regurgitated when a sufferer lies down at night.

Signs and symptoms:

The main symptoms of achalasia are dysphagia (difficulty in swallowing) and regurgitation of undigested food. Dysphagia tends to become progressively worse over time and to involve both fluids and solids.

•Backflow (regurgitation) of food
•Chest pain, which may increase after eating or may be felt in the back, neck, and arms
•Cough
•Difficulty swallowing liquids and solids
•Heartburn
•Unintentional weight loss

Causes:
A muscular ring at the point where the esophagus and stomach come together (lower esophageal sphincter) normally relaxes during swallowing. In people with achalasia, this muscle ring does not relax as well. The reason for this problem is damage to the nerves of the esophagus.

Cancer of the esophagus or upper stomach and a parasite infection that causes Chagas disease may have symptoms like those of achalasia.

Achalasia is a rare disorder. It may occur at any age, but is most common in middle-aged or older adults. This problem may be inherited in some people.

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Diagnosis:
Due to the similarity of symptoms, achalasia can be mistaken for more common disorders such as gastroesophageal reflux disease (GERD), hiatus hernia, and even psychosomatic disorders. Specific tests for achalasia are barium swallow and esophageal manometry. In addition, endoscopy of the esophagus, stomach and duodenum (esophagogastroduodenoscopy or EGD), with or without endoscopic ultrasound, is typically performed to rule out the possibility of cancer. The internal tissue of the esophagus generally appears normal in endoscopy, although a “pop” may be observed as the scope is passed through the non-relaxing lower esophageal sphincter with some difficulty, and food debris may be found above the LES.

Barium swallow:
..CLICK & SEE
The patient swallows a barium solution, with continuous fluoroscopy (X-ray recording) to observe the flow of the fluid through the esophagus. Normal peristaltic movement of the esophagus is not seen. There is acute tapering at the lower esophageal sphincter and narrowing at the gastro-esophageal junction, producing a “bird’s beak” or “rat’s tail” appearance. The esophagus above the narrowing is often dilated (enlarged) to varying degrees as the esophagus is gradually stretched over time.[4] An air-fluid margin is often seen over the barium column due to the lack of peristalsis. A five-minute timed barium swallow can provide a useful benchmark to measure the effectiveness of treatment.

Esophageal manometry:
  CLICK & SEE THE PICTURE
Because of its sensitivity, manometry (esophageal motility study) is considered the key test for establishing the diagnosis. A thin tube is inserted through the nose, and the patient is instructed to swallow several times. The probe measures muscle contractions in different parts of the esophagus during the act of swallowing. Manometry reveals failure of the LES to relax with swallowing and lack of functional peristalsis in the smooth muscle esophagus.

Biopsy:
Biopsy, the removal of a tissue sample during endoscopy, is not typically necessary in achalasia, but if performed shows hypertrophied musculature and absence of certain nerve cells of the myenteric plexus, a network of nerve fibers that controls esophageal peristalsis

Treatment:
The approach to treatment is to reduce the pressure at the lower esophageal sphincter. Therapy may involve:

•Injection with botulinum toxin (Botox). This may help relax the sphincter muscles, but any benefit wears off within a matter of weeks or months.
•Medications, such as long-acting nitrates or calcium channel blockers, which can be used to relax the lower esophagus sphincter
•Surgery (called an esophagomyotomy), which may be needed to decrease the pressure in the lower sphincter. Click to see the pictures:
•Widening (dilation) of the esophagus at the location of the narrowing (done during esophagogastroduodenoscopy)
Your doctor can help you decide which treatment is best for your situation.

Alternative medicine:
Temporary improvement of achalasia symptoms in some cases has been reported with acupuncture


Possible Complications:

•Backflow (regurgitation) of acid or food from the stomach into the esophagus (reflux)
•Breathing food contents into the lungs, which can cause pneumonia
•Tearing (perforation) of the esophagus.

Prognosis: The outcomes of surgery and nonsurgical treatments are similar. Sometimes more than one treatment is necessary.

Lifestyle changes:
Both before and after treatment, achalasia patients may need to eat slowly, chew very well, drink plenty of water with meals, and avoid eating near bedtime. Raising the head of the bed or sleeping with a wedge pillow promotes emptying of the esophagus by gravity. After surgery or pneumatic dilatation, proton pump inhibitors can help prevent reflux damage by inhibiting gastric acid secretion; and foods that can aggravate reflux, including ketchup, citrus, chocolate, alcohol, and caffeine, may need to be avoided.

Prevention:
Many of the causes of achalasia are not preventable. However, treatment of the disorder may help to prevent complications.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://www.bbc.co.uk/health/physical_health/conditions/achalasia.shtml
http://en.wikipedia.org/wiki/Achalasia
http://www.nlm.nih.gov/medlineplus/ency/article/000267.htm

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One thought on “Achalasia”

  1. hi iam suffering from akalasia long back. surgeory done but no result .please advice me cure this problem.iam from india ,hyderabad

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