Online Medic - Achalasia
Achalasia is a disorder of the motor function of the esophagus. Resulted in aperistalsis and failure of the lower esophageal sphincter while swallowing.
It is characterized by degeneration of the ganglionic cells of the myenteric plexus in the esophagus which affects the coordination of the peristalsis. A similar symptom is also manifested via infection by Trypanosoma Cruzi which is common in South America.
Achalasia is associated with Addison’s disease and alacrimation and known as Triple A Syndrome. Patient complaints of intermittent dysphagia of liquids and solids. Patient losses weight and complaining of cramping / atypical retrosternal chest pain.
Pathologically, the esophagus can be elongated and severely dilated. Microscopically, there will be degeneration of the intramural ganglion cells of the esophageal myenteric plexus. There will be degeneration of the dorsal vagal nucleus in the brainstem medulla.
The investigations required include blood test, chest x ray, barium swallow, esophagoscopy and manometry. .
Blood test is needed to exclude Changas’ disease. This is based on the serology for antibodies against T.cruzi. Blood film is useful to detect parasites.
Chest x ray will reveal fluid level behind heart and dilated esophagus. This is indicated by double right heart border.
Manometry will measure the pressure of the esophageal sphincter. Abnormal sphincter resting pressure is more than 30 mmHg.
Barium swallow test will show the dilated body of the esophagus. This will smoothly tapers down to the sphincter with a bird beak shaped appearance and lack of peristalsis.
Esophagoscopy will exclude malignancy.
Treatments include medical and surgical approaches. Medical treatment consists of administration of verapamil or nifedipine. Short term relief is provided by isosorbide mononitrate. Other options include endoscopic injection of botulinum toxin or endoscopic dilation of the balloon of the lower esophageal sphincter.
Surgical treatment includes Heller’s cardiomyotomy of lower esophageal sphincter through thoracic or abdominal approaches. However it carries the risk of reflux esophagitis. Therefore fundoplication procedure is considered to prevent relief.
The complications of achalasia include aspiration pneumonia, weight loss and malnutrition. There is a risk of esophageal malignancy.
The prognosis is good. However, if it is untreated there will be pressure on mediastinal structures due to the dilation of the esophagus.
It is characterized by degeneration of the ganglionic cells of the myenteric plexus in the esophagus which affects the coordination of the peristalsis. A similar symptom is also manifested via infection by Trypanosoma Cruzi which is common in South America.
Achalasia is associated with Addison’s disease and alacrimation and known as Triple A Syndrome. Patient complaints of intermittent dysphagia of liquids and solids. Patient losses weight and complaining of cramping / atypical retrosternal chest pain.
Pathologically, the esophagus can be elongated and severely dilated. Microscopically, there will be degeneration of the intramural ganglion cells of the esophageal myenteric plexus. There will be degeneration of the dorsal vagal nucleus in the brainstem medulla.
The investigations required include blood test, chest x ray, barium swallow, esophagoscopy and manometry. .
Blood test is needed to exclude Changas’ disease. This is based on the serology for antibodies against T.cruzi. Blood film is useful to detect parasites.
Chest x ray will reveal fluid level behind heart and dilated esophagus. This is indicated by double right heart border.
Manometry will measure the pressure of the esophageal sphincter. Abnormal sphincter resting pressure is more than 30 mmHg.
Barium swallow test will show the dilated body of the esophagus. This will smoothly tapers down to the sphincter with a bird beak shaped appearance and lack of peristalsis.
Esophagoscopy will exclude malignancy.
Treatments include medical and surgical approaches. Medical treatment consists of administration of verapamil or nifedipine. Short term relief is provided by isosorbide mononitrate. Other options include endoscopic injection of botulinum toxin or endoscopic dilation of the balloon of the lower esophageal sphincter.
Surgical treatment includes Heller’s cardiomyotomy of lower esophageal sphincter through thoracic or abdominal approaches. However it carries the risk of reflux esophagitis. Therefore fundoplication procedure is considered to prevent relief.
The complications of achalasia include aspiration pneumonia, weight loss and malnutrition. There is a risk of esophageal malignancy.
The prognosis is good. However, if it is untreated there will be pressure on mediastinal structures due to the dilation of the esophagus.