Achalasia

21:53 - 4 May , 2021

Disease

What is Achalasia?

It is a condition in which the esophagus nerves are injured, causing muscle paralysis that makes it difficult to transport food and drink to the stomach, causing food to accumulate and ferment, returning to the oral cavity. So it is sometimes associated with gastroesophageal reflux, but in the case of achalasia, food comes from the esophagus, not the stomach.

Its origin is unknown, but research indicates that it is due to a dysfunction of the esophagus nerve cells due to autoimmune effects or viral infections.

Symptoms

Symptoms are gradual, but usually worsen over time, and are characterized by:

  • Heartburn.
  • Decreased body weight.
  • Difficulty swallowing food.
  • Intermittent chest pain.
  • Continuous belching.
  • Pneumonia due to pulmonary aspiration of food.
  • Regurgitated food.
  • Coughing fits, especially when lying down.
  • Vomit.

It is important to see your doctor as soon as possible if you have any of these symptoms. If the esophagus completely stops its function, it will be difficult to perform it correctly again.

Diagnosis and treatment

Once your doctor analyzes your symptoms and clinical history, he or she will perform a physical examination and tests that allow him or her to determine if it is achalasia since the symptoms are similar to other digestive system ailments:

  • Upper endoscopy: to help define if there is a partial obstruction of the esophagus or take a tissue sample to test for reflux complications such as Barrett’s esophagus.
  • Esophagogram: to view the esophagus, stomach, and small intestine, as well as to assess a possible obstruction of the esophagus.
  • Esophageal manometry: which allows measuring muscular contractions of the esophagus when swallowing, the esophagus muscles’ strength, and the correct opening of the esophageal sphincter when swallowing.

At this time, there is no cure for achalasia, but it can be managed with the right treatment for your age, general health, and the level of disease progression. In general, medical management consists of stretching the opening of the esophageal sphincter so that food and drink are transported without any problem to the stomach, through:

  • Calcium channel blockers and nitrates that help dilate the narrow part of the esophagus.
  • Muscle relaxants.
  • Pneumatic dilatation, which involves inserting a balloon into the esophageal sphincter through endoscopy to enlarge the esophagus opening.
  • Botox injections.
  • Laparoscopic Heller myotomy, where the muscle of the esophageal sphincter is cut to allow food to move with greater ease into the stomach.
  • Oral endoscopic myotomy, in which a tube is inserted through the mouth and down the throat to make an incision in the esophagus and then cut the esophageal sphincter muscle.

In both surgical procedures, gastroesophageal reflux may occur later, so your doctor may perform a fundoplication at the same time, which is a minimally invasive surgery, to prevent this disease. In ABC Medical Center’s Internal Medicine Department, we offer health care services with the highest quality and safety, from the prevention, diagnosis, timely treatment, and monitoring of infectious, respiratory, endocrinological, dermatological, rheumatic, nephrological, gastrointestinal, and hematological pathologies of both chronic-degenerative diseases and acute conditions, through a comprehensive and multidisciplinary model.

Fuentes:

  • revistagastroenterologiamexico.org
  • mayoclinic.org
  • medlineplus.gov
  • msdmanuals.com
  • miendoscopia.com
  • medigraphic.com
  • Aragón VJI. Acalasia: Manifestaciones clínicas y diagnóstico. Rev Med Cos Cen. 2015;72(615):257-259.
  • del Pino-García M, Murray-Hurtado M, Hernández-Ponce JA, et al. Acalasia cricofaríngea: a propósito de un caso. Rev Mex Pediatr. 2019;86(6):234-237. doi:10.35366/91875.
  • Avelar-Rodríguez D, Toro-Monjaraz EM, Peña VR, et al. Paciente con acalasia esofágica e inmunodeficiencia común variable. Reporte de caso y revisión bibliográfica. Acta Pediatr Mex. 2019;40(3):143-147.
  • Rojas PY, Trujillo PYL, Brito AG, et al. La toxina botulínica como alternativa de tratamiento en pacientes con acalasia. AMC. 2018;22(5):677-693.

						
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