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Encyclopedia > Achalasia
Achalasia
Classification & external resources
ICD-10 K22.0
ICD-9 530.0
OMIM 200400
DiseasesDB 72
MedlinePlus 000267
eMedicine radio/6  med/16
MeSH C06.405.117.119.500.432

Achalasia, also known as esophageal achalasia, achalasia cardiae, cardiospasm, dyssynergia esophagus, and esophageal aperistalsis, is an esophageal motility disorder. In this disorder, inappropriate contraction of the smooth muscle layer of the esophagus leads to reduced peristalsis (muscular ability to move food down the esophagus) and failure of the lower esophageal sphincter (LES) to relax properly in response to swallowing. The most common form is primary achalasia (with no underlying cause), but a small proportion is due to esophageal cancer or (in South America) Chagas disease. The International Statistical Classification of Diseases and Related Health Problems (commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following codes are used with International Statistical Classification of Diseases and Related Health Problems. ... // K00-K93 - Diseases of the digestive system (K00-K14) Diseases of oral cavity, salivary glands and jaws (K00) Disorders of tooth development and eruption (K01) Embedded and impacted teeth (K02) Dental caries (K03) Other diseases of hard tissues of teeth (K04) Diseases of pulp and periapical tissues (K040) Pulpitis (K05... The International Statistical Classification of Diseases and Related Health Problems (commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... The Mendelian Inheritance in Man project is a database that catalogues all the known diseases with a genetic component, and - when possible - links them to the relevant genes in the human genome. ... The Diseases Database is a free website that provides information about the relationships between medical conditions, symptoms, and medications. ... MedlinePlus (medlineplus. ... eMedicine is an online clinical medical knowledge base that was founded in 1996. ... Medical Subject Headings (MeSH) is a huge controlled vocabulary (or metadata system) for the purpose of indexing journal articles and books in the life sciences. ... An esophageal motility disorder is a medical disorder causing difficulty in swallowing, regurgitation of food, and, in some people, a spasm-type pain. ... Smooth muscle is a type of non-striated muscle, found within the walls of hollow organs; such as blood vessels, the bladder, the uterus, and the gastrointestinal tract. ... The esophagus (also spelled oesophagus/Å“sophagus, Greek ), or gullet is an organ in vertebrates which consists of a muscular tube through which food passes from the mouth area to the stomach. ... In much of the digestive tract, muscles contract in sequence to produce a peristaltic wave which forces food (called bolus while in the esophagus and chyme below the esophagus) along the alimentary canal. ... It has been suggested that this article or section be merged with Cardia. ... Swallowing, known scientifically as deglutition, is the reflex in the human body that makes something pass from the mouth, to the pharynx, into the esophagus, with the shutting of the epiglottis. ... Esophageal cancer is malignancy of the esophagus. ...

Contents

Signs and symptoms

The classical triad of achalasia is dysphagia (difficulty swallowing) to fluids and later solids, regurgitation of undigested food, and chest pain. Other symptoms may include difficulty belching, frequent hiccups, cough (especially on reclining) and weight loss (due to inadequate nutrient intake). Dysphagia (, not to be confused with dysphasia) is a medical term defined as difficulty swallowing. It derives from the Greek root dys meaning difficulty or disordered, and phagia meaning to eat. It is a sensation that suggests difficulty in the passage of solids or liquids from the mouth to the... Regurgitation is the passive flow of stomach contents back into the esophagus and mouth. ... In medicine, chest pain is a symptom of a number of serious conditions and is generally considered a medical emergency, unless the patient is a known angina pectoris sufferer and the symptoms are familiar (appearing at exertion and resolving at rest, known as stable angina). // Causes Cardiopulmonary Important cardiovascular and... The process of burping, also known as a belching or eructation, is an often audible release through the mouth of gas that has accumulated in the stomach or esophagus. ... A hiccup or hiccough (generally pronounced HICK-cup (IPA: ) independent of the spelling) is an involuntary spasm of the diaphragm; typically this repeats several times a minute. ... Weight loss, in the context of medicine or health, is a reduction of the total body weight, which can mean loss of fluid, muscle or bone mass, or fat. ...


Diagnosis

Due to the similarity of symptoms, achalasia can be misdiagnosed as other disorders, such as gastroesophageal reflux disease (GERD), hiatus hernia, and even psychosomatic disorders. It has been suggested that heartburn be merged into this article or section. ... Hiatus hernia or hiatal hernia is the protrusion (or herniation) of the upper part of the stomach into the thorax through a tear or weakness in the diaphragm. ... A psychosomatic illness is one with physical manifestations and supposed psychological cause, often diagnosed when any known or identifiable physical cause was excluded by medical examination. ...


Investigations for achalasia include

  • X-ray with a barium swallow, or esophagography. This shows narrowing at the level of the gastroesophageal junction ("bird/parrot beak" or "rat tail" presentation of the lower esophagus) and various degrees of megaesophagus (esophageal dilation) as the esophagus is gradually stretched by retained food. A five-minute timed barium swallow is useful to measure the effectiveness of treatment.
  • Manometry, the key test for establishing the diagnosis. A probe measures the pressure waves in different parts of the esophagus and stomach during the act of swallowing. A thin tube is inserted through the nose, and the patient is instructed to swallow several times (this is called a nasogastric intubation).
  • Endoscopy, which provides a view inside the esophagus and stomach. A small camera is inserted through the mouth .
  • CT scan may be used to exclude pseudoachalasia, or achalasia symptoms resulting from a different cause, usually esophageal cancer.

Pathological examination reveals a defect in the nerves that control the motility of the esophagus (the myenteric plexus). The esophagus is dilatated and hypertrophied. In Chagas disease, the ganglion cells are destroyed by Trypanosoma cruzi, the causative parasite.[1] In the NATO phonetic alphabet, X-ray represents the letter X. An X-ray picture (radiograph) taken by Röntgen An X-ray is a form of electromagnetic radiation with a wavelength approximately in the range of 5 pm to 10 nanometers (corresponding to frequencies in the range 30 PHz... A barium meal is a procedure in which barium barium sulfate is ingested by a patient and, in conjunction with X-rays, images depicting the the distal esophagus, stomach and duodenum can be obtained digestive system. ... In medicine, manometry is a study performed to examine the pression of one part of the body, generally the muscle function of the esophagus. ... Nasogastric intubation is a medical process involving the insertion of a plastic tube (nasogastric tube, NG tube) through the nose, past the throat, and down into the stomach. ... Endoscopic images of a duodenal ulcer Endoscopy means looking inside and refers to looking inside the human body for medical reasons. ... CAT apparatus in a hospital Computed axial tomography (CAT), computer-assisted tomography, computed tomography, CT, or body section roentgenography is the process of using digital processing to generate a three-dimensional image of the internals of an object from a large series of two-dimensional X-ray images taken around... Esophageal cancer is malignancy of the esophagus. ... Pathology (from Greek pathos, feeling, pain, suffering; and logos, study of; see also -ology) is the study of the processes underlying disease and other forms of illness, harmful abnormality, or dysfunction. ... Part of the enteric nervous system, Auerbachs plexus (or myenteric plexus) exists between the longitudinal and circular layers of muscularis externa in the gastrointestinal tract and provides motor innervation to both layers and secretomotor innervation to the mucosa. ... Bodybuilder Markus Rühl has marked hypertrophy of skeletal muscle. ... Chagas disease (also called American trypanosomiasis) is a Mammalian disease occurring only in the Americas. ...


Complications

  1. Gastroesophageal reflux disease (GERD) or heartburn.
  2. Barrett's esophagus or Barrett's mucosa: in 10% of patients.
  3. There are two kinds of esophageal cancer: squamous cell carcinoma and adenocarcinoma. Achalasia is a predisposing condition that may lead to esophageal adenocarcinoma if present for a long time. In up to 5% of cases, Barrett's esophagus leads to esophageal adenocarcinoma.[citation needed]
  4. Aspiration pneumonia: food, liquid, and saliva is retained in the esophagus, and patients may breathe it into the lungs, especially while sleeping in a horizontal position.

Endoscopic image of Barretts esophagus, which is the area of red mucosa projecting like a tongue. ... The mucous membranes (or mucosa) are linings of ectodermic origin, covered in epithelium, that line various body cavities and internal organs. ... Esophageal cancer is malignancy of the esophagus. ... Biopsy of a highly differentiated squamous cell carcinoma of the mouth. ... Adenocarcinoma is a form of carcinoma that originates in glandular tissue. ... Aspiration pneumonia is a specific form of lung infection (pneumonia) that develops when oral or gastric contents (including food, saliva, or nasal secretions) enter the bronchial tree. ...

Treatment

  • Medication:
    • Intra-sphincteric injection of botulinum toxin (or botox), to paralyze the lower esophageal sphincter and prevent spasms. As in the case of botox injected for cosmetic reasons, the result is only temporary, and symptoms return quickly in most of patients. Botox injections cause scarring in the sphincter which may increase the difficulty of later Heller myotomy. This therapy is only recommended for elderly patients who cannot risk surgery.
    • Drugs that reduce LES pressure may be useful, especially as a way to buy time while waiting for surgical treatment. These include calcium channel blockers such as nifedipine, and nitrates such as isosorbide dinitrate and nitroglycerin. Unfortunately, many patients experience unpleasant side effects such as headache and swollen feet, and these drugs often stop helping after several months.
  • Balloon (pneumatic) dilation, also called dilatation. The muscle fibers are stretched and slightly torn by forceful inflation of a balloon placed inside the lower esophageal sphincter. Gastroenterologists who specialize in achalasia and have done many of these forceful balloon dilations have better results and fewer perforations than inexperienced ones. There's always a small risk of a perforation which would have to be fixed by surgery right away. Gastroesophageal reflux (GERD) occurs after pneumatic dilation in some patients. Pneumatic dilation causes some scarring which may increase the difficulty of Heller myotomy if this surgery is needed later. Pneumatic dilation is most effective on the long term in patients over the age of 40; the benefits tend to be shorter-lived in younger patients. This treatment may need to be repeated with larger balloons for maximum effectiveness.
  • Surgery: Heller myotomy helps 90% of achalasia patients. It can usually be performed by a keyhole approach, or laparoscopically. The myotomy is a lengthwise cut along the esophagus, starting above the LES and extending down onto the stomach a little way. The esophagus is made of several layers, and the myotomy only cuts through the outside muscle layers which are squeezing it shut, leaving the inner muscosal layer intact. A partial fundoplication or "wrap" is added in order to prevent excessive reflux, which can cause serious damage to the esophagus over time. In a Dor (anterior) fundoplication, part of the stomach is laid over the esophagus and stitched in place so whenever the stomach contracts, it also closes off the esophagus instead of squeezing stomach acids into it. After surgery, patients should keep to a soft diet for several weeks to a month, avoiding foods that can aggravate reflux.
  • Lifestyle changes: Achalasia patients need to eat slowly, chew very well, drink plenty of water with meals, and avoid eating near bedtime. It is helpful to sleep with the head elevated by raising the head of the bed or using a wedge pillow. Proton pump inhibitors may help prevent reflux damage after surgery by inhibiting gastric acid secretion. Foods that can aggravate reflux, including ketchup and other tomato products, citrus fruits, chocolate, mint, alcohol, and caffeine, should also be avoided.
  • Follow-up monitoring: Even after successful treatment of achalasia, swallowing may still deteriorate over time. It's important to check every year or two with a timed barium swallow because some may need pneumatic dilations, a repeat myotomy, or even esophagectomy after many years. Some doctors recommend pH testing and endoscopy to check for reflux damage, which may lead to a stricture or cancer of the esophagus if untreated.

Look up Sphincter in Wiktionary, the free dictionary. ... Botulinum toxin is a neurotoxic protein produced by the bacterium Clostridium botulinum. ... A spasm is a sudden, involuntary contraction of a muscle, a group of muscles, or a hollow organ, or a similarly sudden contraction of an orifice. ... Heller myotomy is a form of laparoscopic surgery that is considered minimally invasive. ... Calcium channel blockers are a class of drugs with effects on the muscle of the heart and the muscles of the rest of the body. ... Nifedipine (brand name Adalat and Procardia) is a dihydropyridine calcium channel blocker. ... Nitrates are the salts of nitric acid. ... Action: Relaxation of smooth muscle of venous and arterial vasculature. ... Nitroglycerin (NG), also known as nitroglycerine, trinitroglycerin, and glyceryl trinitrate, is a chemical compound. ... A headache (medically known as cephalalgia, sometimes spelled as cephalgia) is a condition of pain in the head; sometimes neck or upper back pain may also be interpreted as a headache. ... This does not cite its references or sources. ... Heller myotomy is a form of laparoscopic surgery that is considered minimally invasive. ... Laparoscopic surgery, also called keyhole surgery (when natural body openings are not used), bandaid surgery, or minimally invasive surgery (MIS), is a surgical technique. ... Nissen fundoplication is a surgical procedure to treat gastroesophageal reflux disease (GERD) and hiatus hernia. ... A soft diet is recommended in many situations, including some types of dysphagia (difficulty swallowing), surgery involving the mouth or gastrointestinal tract, and pain from newly adjusted braces. ... It has been suggested that Complementary and Alternative Medicine be merged into this article or section. ... Acupuncture (from Lat. ... Herbology is the art of combining medicinal herbs. ... Look up relaxation in Wiktionary, the free dictionary. ... Proton pump inhibitors are a group of drugs whose main action is pronounced and long-lasting reduction of gastric acid production. ... It has been suggested that heartburn be merged into this article or section. ... Surgical excision of part of or the entire esophagus Categories: Medicine stubs ...

References

  1. ^ (2001) Rubin's Pathology - Clinicopathological Foundations of Medicine. Maryland: Lippincott Williams & Wilkins, p. 665. ISBN 0-7817-4733-3. 

External links


  Results from FactBites:
 
MGC-Achalasia (997 words)
Achalasia is a rare disease of the muscle of the esophagus (swallowing tube) which is usually diagnosed in young adults.
The term achalasia means "failure to relax" and refers to one of the abnormalities of the esophagus seen in the disease, specifically, the inability of the muscle at the lower end of the esophagus (the lower esophageal sphincter) to open and let food pass into the stomach.
In achalasia, the video-esophagram shows that the esophagus is dilated (enlarged or widened), with a characteristic tapered narrowing of the lower end sometimes likened to a "bird's beak." In addition, the barium stays in the esophagus longer than normal before passing into the stomach.
Achalasia (6594 words)
Achalasia is an esophageal motor disorder characterized by failure of relaxation of the lower esophageal sphincter and lack of progressive peristalsis in the esophageal body.
Achalasia is a motor disorder of the oesopagus characterized by decrease in ganglion cell density in Auerbach's plexus.
Achalasia is characterized by failure of relaxation of the lower esophageal sphincter and absence of progressive peristalsis in the esophageal body.
  More results at FactBites »

 
 

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