Achalasia

Introduction

Achalasia (kardiospazam, oesophageal antiperistaltika, megaezofagus) is a nerve disorder of unknown cause that can be confronted with two processes: the rhythmic waves of contraction that push food down the esophagus, called peristalsis, and with the opening of the esophageal sphincter.

Ahalaziju may cause malfunction of the nerves that surround the esophagus and supplies his muscles.

Symptoms and Complications

Achalasia can occur at any age of life, but almost unrecognized usually starts between the ages of 20-40 years and then gradually progresses months and years. The main symptom is difficulty swallowing and solid and liquid food.Pinched lower oesophageal sphincter causes the esophagus above it significantly expanded.

Other symptoms may include chest pain, vomiting facilities extended esophagus and cough at night. Although rarely, chest pain may be caused by swallowing or for some vague cause. About a third of people who have returned ahalaziju undigested food apnea. They can be inhaled into the lungs due to food which may lead to the development of lung abscess, bronchiectasis (enlargement and infections of the respiratory tract) or aspiration pneumonia.Achalasia is a risk factor for esophageal cancer, although such a cancer probably get less than 5% of people with achalasia.

Diagnosis and prognosis

Rtg esophagus made during the time a person swallows barium porridge shows absence of peristalsis. The esophagus is expanded, often of enormous size, while in the lower esophageal sphincter narrowed. Measuring the pressure inside the esophagus (manometry) indicates the absence of contraction, increasing pressures closing lower esophageal sphincter and incomplete opening of the sphincter when a person swallows. Esophagoscopy (of the esophagus through a flexible tube with a video camera observation) indicates expansion, but not narrowing (obstruction).

When esophagoscopy doctor for a biopsy (take tissue samples for examination under a microscope) to make sure the symptoms are not due to cancer in the lower part of the esophagus. Viewing is done and to cut out as the cause of scleroderma, a disease that affects the muscles and can make it difficult to swallow.

Often the cause of achalasia is not serious and does not lead to any serious illness. Prognosis is not so good if gastric contents into lungs because lung complications difficult to treat.

Treatment

The aim of treatment is easier to open the lower esophageal sphincter. The first approach is to expand the sphincter mechanical, eg inflating a balloon inside the sphincter. The results of this procedure in 40% of cases satisfactorily, but may be required and repeated expansion. Nitrates (such as nitroglycerin placed under the tongue before meals) or calcium channel blockers (eg, nifedipine) may delay the need for a second procedure to expand, because they help relax the sphincter. In less than 1% of the esophagus may rupture during the expansion, leading to inflammation of the surrounding tissue (mediastinitis). To close the rift in the wall of the esophagus is required immediate surgical intervention.

As an alternative to mechanical expansion doctor may lower oesophageal sphincter inject venom botulinus. This newer treatment is as effective as mechanical expansion, but long-term effects are not yet known.

If you expand or treating poison botulinus are not successful, surgery is usually performed cutting muscle or the lower esophageal sphincter. The surgery is successful in about

85% of cases. However, in about 15% of people after surgery with occasional return (reflux) acid.