Achalasia is believed to be a multifactorial disease, but the exact factors leading to the degeneration of ganglion cells in the myenteric plexus of the esophagus have so far been poorly understood.1 Regarding the pathophysiology there can be either extrinsic or intrinsic causes responsible for the loss of the inhibitory innervation of the esophagus. Extrinsic causes may include central nervous system lesions involving the dorsal motor neuron or the vagal nerve fibers, although it is also possible that the vagal nerve degeneration and the loss of dorsal motor nucleus neurons are a secondary phenomenon caused by the loss of contact with the end organ, the myenteric plexus of the esophagus.2 Intrinsic causes may lead to the primary loss of the inhibitory ganglion cells in the myenteric plexus, which results in the imbalance between the excitatory and inhibitory neurons of the myenteric plexus. In humans, nitric oxide is the primary inhibitory neurotransmitter in the myenteric plexus. In achalasia patients, a significant decrease in nitric oxide neurons in the lower esophageal sphincter (LES) has been demonstrated compared to normal controls.3 In the background of the abovementioned pathophysiological changes, several diseases can be suspected.
In the present case study we report a case of a 65 year-old woman. In her medical history she had typical reflux symptoms with heartburn and regurgitation for about seven years. She had no complaints of dysphagia at that time.
Some people with achalasia are at risk for cancer of the esophagus. For this reason, itâ€™s very important to have regular visits with your doctor. Medication. Two classes of drugs, nitrates and calcium channel blockers, have LES muscle-relaxing effects. These drugs can decrease symptoms in people with achalasia.
Hey Paul! I too, as an SLP, have been dx with achalasia.
An endoscope is also required to facilitate the exposure and to evaluate the extent of the myotomy into the stomach. At the same time, the endoscope can identify a mucosal perforation. All the perforations were diagnosed by a postprocedure esophagogram. They medically treated 6 patients with nasogastric suction, antibiotics, and pleural drainage.
complications of benign esophageal stricture
This inexpensive and readily available study often reveals the classic findings of a dilated esophagus, impaired peristalsis, and the pathognomonic smooth tapering at the gastroesophageal junction (GEJ) commonly termed “bird’s beak” esophagus. If diagnosed early, the esophagus may be of normal caliber (Figure 1a), though most patients present with some element of dilation (Figure 1b). Commonly an air-fluid level forms as esophageal emptying is delayed, or the barium tablet or marshmallow “hangs up” just above the GEJ and may require several minutes to pass.
What is esophageal achalasia?
- The aim of treatment is to relieve symptoms by decreasing pressure in the lower esophageal sphincter.
- Some patients may develop GERD after this procedure.
- But most people with achalasia will find it difficult to swallow food or drink (known as dysphagia).
- These include issues related to tearing of the esophagus, acid reflux, or respiratory conditions caused by food traveling up your esophagus and into your windpipe.
- Then the area at the level of the LES became very sore, with a pinching type of heartburn because at that point acid was damaging the esophagus there.
The injections are done endoscopically and the main appeal of the procedure is that there are few side effects, low risk of complications, and recovery is generally rapid and uncomplicated. Symptoms frequently reoccur and subsequent injections are needed in many people who choose this treatment.
Treatment for esophageal spasm includes treating other conditions that may make esophageal spasms worse, such as gastroesophageal reflux disease (GERD). GERD is usually treated with changes to diet and lifestyle and medicines to reduce the amount of acid in the stomach. Other tests may be done to find out whether chest pain may be caused by gastroesophageal reflux disease (GERD), the abnormal backflow (reflux) of food, stomach acid, and other digestive juices from the stomach into the esophagus. Botox (botulinum toxin type A). This muscle relaxant can be injected directly into the esophageal sphincter with an endoscope.
Researchers found esophageal nerve cells become damaged due to miscued immune responses after an earlier viral infection, which I think is exactly what happened to me. They believe it also involves a genetic predisposition, which jibes with my case, as my father had achalasia. Other sources also cite the immune system as a contributor to achalasia.
The histological findings showed a mild chronic inflammation without any typical signs of reflux disease in 21 cases and a normal esophageal mucosa in 19 cases. The two patients with clinical signs of reflux were among those with mild chronic inflammation.
Eighty percent of patients with GERD also have a hiatal hernia, and during the fundoplication procedure, the hernial sac may also be surgically fixed. The procedure can be done with laparotomy, thoracotomy, or laparoscopy. Esophageal CancerEsophageal cancer is a disease in which malignant cells form in the esophagus. Risk factors of cancer of the esophagus include smoking, heavy alcohol use, Barrett’s esophagus, being male and being over age 60. Severe weight loss, vomiting, hoarseness, coughing up blood, painful swallowing, and pain in the throat or back are symptoms.
The injections may need to be repeated, and repeat injections may make it more difficult to perform surgery later if needed. Botox is generally recommended only for people who aren’t good candidates for pneumatic dilation or surgery due to age or overall health. Achalasia treatment focuses on relaxing or forcing open the lower esophageal sphincter so that food and liquid can move more easily through your digestive tract.