The achalasia is a disease rare, a gastrointestinal disorder included among esophageal and swallowing disorders. In achalasia the esophagus loses the ability to conduct food and liquids towards the stomach because there are few or no peristaltic contractions to push them and because the valve that connects the esophagus to the stomach (lower esophageal sphincter) does not relax completely to allow them to pass. . There is no cure but the symptoms can be relieved. It affects men and women of any age but usually appears between the ages of 20 and 60, progressing gradually. It can be hereditary.
Causes of achalasia
Denervation
Its cause is still unknown although it is suspected that it may be of viral or immune infectious origin. In fact, achalasia is a symptom of Chagas disease, an infection that is transmitted by the bite of a bedbug.
It is known that it can be hereditary in some cases and that it is caused by a dysfunction of the nerves or alterations in the nervous structures of the esophagus (denervation) that control the peristaltic contractions that carry food and liquids towards the stomach.
Symptoms of achalasia
Stopping food mid-breast
The first symptom of achalasia is usually the sensation that solid food stops mid-chest. It happens suddenly, at first only with solid foods and not every day. Little by little, difficulty swallowing liquids also appears and can worsen with cold drinks or when experiencing some type of emotion. Achalasia is suspected if there is:
– Difficulty swallowing solids and liquids (dysphagia).
– Chest pain during swallowing for no apparent reason.
– Regurgitation, even during sleeping hours, of undigested food.
– Weight loss.
– If regurgitant food and liquid is aspirated into the lungs, aspiration pneumonia, respiratory tract infection, or lung abscesses may occur.
Diagnosis of achalasia
Medical history and tests
The diagnosis of achalasia can be delayed because it can be confused with other disorders. The doctor or gastroenterology specialist, if they suspect achalasia, may order the following tests:
– Esophageal manometry to measure peristaltic contractions, the coordination of the esophageal muscles and their strength. It also measures the relaxation and opening of the lower esophageal sphincter during swallowing.
– X-rays to see if there is poor emptying of the esophagus, especially with the patient lying down. Normally the esophagus looks dilated at the top and narrower at the bottom. Food retained inside the esophagus is usually seen. In advanced stages of the disease the esophagus becomes longer and tortuous.
– Endoscopy to rule out tumors. It allows checking the dilation of the esophagus and the resistance to the passage of the endoscope towards the stomach.
Achalasia treatment and medication
Opening of the esophageal sphincter
Achalasia has no cure, so treatment focuses on relaxing and/or opening the lower esophageal sphincter to facilitate the passage of food and liquids. This can be achieved without surgery or with it.
Non-surgical options are:
– Pneumatic dilation by introducing a balloon that will be inflated to enlarge the opening. The procedure may need to be repeated several times and has its risks, although rare, such as respiratory infections or perforation of the esophageal wall. The latter will require repair surgery.
– Botox injection directly into the esophageal sphincter with an endoscope. Transient effects of less than 1 year.
– Medication with muscle relaxants such as nitroglycerin or nifedipine before eating. It provides temporary relief and is recommended for those who are not candidates for pneumatic dilation or Botox injection.
The surgical option is myotomy in which, using an endoscope, the fibers of the lower esophageal sphincter are removed. It is usually done with laparoscopy or endoscopy. To prevent gastroesophageal reflux, along with myotomy, a fundopicatura is performed to wrap the upper part of the stomach around the lower esophageal sphincter by tightening the muscle.
Prevention of achalasia
Without prevention
Achalasia does not have prevention measures and precautionary recommendations that have been described except for regular clinical check-ups that include manometry, radiography and endoscopy.
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