Achalasia Of The Esophagus - Treatment, Symptoms, Causes

2024 Author: Rachel Wainwright | [email protected]. Last modified: 2023-12-15 07:39

Achalasia

Achalasia of the esophagus is a disease characterized by the absence of reflex opening of the cardia when swallowing. The disease is accompanied by a decrease in the tone of the thoracic esophagus and a violation of intestinal motility.

The disease was first described in 1672. According to statistics, 1 person in 100 thousand suffers from the disease. Most often, achalasia of the esophagus occurs at the age of 40-50 years. Achalasia of the esophagus in children is a rather rare occurrence and accounts for approximately 3.9% of all cases of diseases. Women, as a rule, suffer from this disease several times more often than men.

The most common causes of achalasia

The exact cause of esophageal achalasia is unknown. The most common causes include infectious diseases, external compression of the esophagus, inflammatory processes, malignant tumors, infiltrative lesions, etc.

In children, achalasia of the esophagus is most often diagnosed after the age of five. As a rule, no one pays special attention to the appearance of the first symptoms, therefore, the disease is diagnosed with a delay. The most common symptoms of esophageal achalasia in children are dysphagia and vomiting immediately after a meal.

The most common symptoms of achalasia

Dysphagia is the most important symptom of achalasia. Dysphagia occurs in almost all patients with this disease. As a rule, the time interval between the manifestation of the first signs of the disease and the time to see a doctor varies from 1 to 10 years.

The second most common symptom of achalasia is regurgitation of food debris without admixture of acidic gastric juice and bile as a result of stagnation of contents in the esophagus. This leads to the fact that patients often experience attacks of choking or coughing at night.

Symptoms of achalasia also include heartburn and chest pain. The pains are mainly localized behind the sternum, are of a squeezing or squeezing character and are often given to the back, lower jaw or neck. It happens that in the presence of heartburn, instead of achalasia of the esophagus, the patient is given an erroneous diagnosis, for example, gastroesophageal reflux. However, heartburn with achalasia does not occur after eating and does not subside with the use of antacids.

Complications of esophageal achalasia

Achalasia of the esophagus leads to irreversible changes in the nervous and other systems of the body.

The most common complications of the disease are:

• purulent pericarditis;
• squamous cell carcinoma of the esophagus;
• bezoars of the esophagus;
• exfoliation of the submucous layer of the esophagus;
• lung damage;
• volumetric formations of the neck;
• varicose veins of the esophagus;
• diverticulum of the distal esophagus;
• pneumopericardium, etc.

With long-term achalasia, the esophagus tends to expand significantly, which leads to a thinning of its walls, resulting in the above complications of the disease.

Approximately 85% of patients with achalasia experience significant weight loss.

Diagnosis of esophageal achalasia

At different stages of achalasia, there is only cardia obstruction with insignificant dilatation of the proximal part. As the disease progresses, characteristic signs can be seen on the X-ray: expansion of the esophagus, in the lower section of the clinical narrowing for a short distance with a coracoid expansion in place of the narrowed section. Despite the fact that the clinical picture of the disease is quite characteristic, it can often be confused with esophageal cancer in patients over the age of 50, especially in its early stages.

Esophagoscopy has the greatest benefit in the diagnosis of achalasia. The confirmation of the clinical manifestations of achalasia is the study of the motor function of the esophagus. In the esophagus, a low pressure is found with dilatation of its lumen and the absence of peristalsis after swallowing. After swallowing, pressure rises throughout the esophagus. During swallowing, the esophageal sphincter does not open, which makes it possible to speak with precision about the diagnosis of achalasia.

In some patients, the violation of the peristalsis of the esophagus turns into a diffuse spasm, and in response to the act of swallowing, repeated severe spasms occur.

Achalasia treatment

Achalasia of the esophagus is very difficult to treat with medication. Medication for achalasia is used only to relieve the symptoms of the disease. The patient is prescribed a gentle diet, sedatives, vitamin complexes, antispastic agents. Typically, drug therapy only provides temporary relief.

Forced expansion of the cardia is possible through the use of a mechanical, pneumatic or hydrostatic dilator. The most widespread are pneumatic dilatators as the safest.

Under X-ray control, a tube with a balloon at the end is introduced into the stomach. In the lumen of the stomach, the balloon is inflated with air and pulled out. This allows you to expand the lumen of the esophagus. Ruptures of the esophageal wall or mucous membrane can occur with the use of an elastic dilator in about 1% of cases, while when using a mechanical dilator, the percentage increases to 6. In about 80% of cases, dilation has a positive effect and successfully relieves the patient of the painful symptoms of achalasia.

If dilation does not give a positive result, surgical treatment of achalasia can be applied. The most common modern surgical method for treating esophageal achalasia is bilateral cardiomyotomy. The operation consists of a longitudinal dissection of the muscle layers of the distal esophagus. Sometimes, just an anterior cardiomyotomy is sufficient.

After this operation, approximately 90% of patients are cured. Unsatisfactory results are mainly associated with long-term scarring. This operation is the most preferred method of treating esophageal achalasia in children with advanced stages.

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The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!