Achalasia: Difference between revisions
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==Background== | ==Background== | ||
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*Inability of LES to relax and loss of normal peristalsis <ref>Krill JT, Naik RD, Vaezi MF. Clinical management of achalasia: current state | *Inability of LES to relax and loss of normal peristalsis <ref>Krill JT, Naik RD, Vaezi MF. Clinical management of achalasia: current state | ||
of the art. [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4831602/ Clin Exp Gastroenterol. 2016 Apr 4;9:71-82.]</ref> | of the art. [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4831602/ Clin Exp Gastroenterol. 2016 Apr 4;9:71-82.]</ref> | ||
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*[[Special:MyLanguage/Chest pain|Chest pain]] | *[[Special:MyLanguage/Chest pain|Chest pain]] | ||
**Esophageal spasm can feel like tight, crushing retrosternal pain similar to ACS | **Esophageal spasm can feel like tight, crushing retrosternal pain similar to ACS | ||
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*[[Special:MyLanguage/Connective tissue disorders|Connective tissue disorders]] - ''e.g. [[Special:MyLanguage/scleroderma|systemic sclerosis]]'' | *[[Special:MyLanguage/Connective tissue disorders|Connective tissue disorders]] - ''e.g. [[Special:MyLanguage/scleroderma|systemic sclerosis]]'' | ||
*Esophageal spasm - ''chest pain a predominant feature'' | *Esophageal spasm - ''chest pain a predominant feature'' | ||
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*Esophageal Manometry | *Esophageal Manometry | ||
[[File:Manometry.jpg|thumbnail|Aperistaltic contractions, increased intraesophageal pressure, and failure of relaxation of the lower esophageal sphincter.]] | [[File:Manometry.jpg|thumbnail|Aperistaltic contractions, increased intraesophageal pressure, and failure of relaxation of the lower esophageal sphincter.]] | ||
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*Patients need to eat upright at all times. | *Patients need to eat upright at all times. | ||
*Treatment may improve dysphagia, but there is no cure and swallowing never completely normalizes | *Treatment may improve dysphagia, but there is no cure and swallowing never completely normalizes | ||
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*[[Special:MyLanguage/Ingested foreign body|Ingested foreign body]] | *[[Special:MyLanguage/Ingested foreign body|Ingested foreign body]] | ||
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[[Category:GI]] | [[Category:GI]] | ||
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Revision as of 21:33, 4 January 2026
Background
- Inability of LES to relax and loss of normal peristalsis [1]
Clinical Features
- Dysphagia
- Regurgitation
- Chest pain
- Esophageal spasm can feel like tight, crushing retrosternal pain similar to ACS
Differential Diagnosis
- Ingested foreign body
- Esophageal carcinoma - dysphagia predominantly for solid foods during initial stages
- Reflux esophagitis - dysphagia results from inflammatory swelling or a fibrotic stricture
- Pseudoachalasia - underlying malignancy mimics achalasia
- Connective tissue disorders - e.g. systemic sclerosis
- Esophageal spasm - chest pain a predominant feature
Evaluation
- Upper GI
- Esophageal dilatation
- Birds beak sign
- Esophageal Manometry
Management
- Trial of antispasmodic for esophageal spasm
- Surgical intervention
- Balloon dilatation
- Botulinum toxin injection [2]
- Myomectomy
- Consider gastrostomy for frail and older patients
- Patients need to eat upright at all times.
- Treatment may improve dysphagia, but there is no cure and swallowing never completely normalizes
Disposition
See Also
External Links
References
- ↑ Krill JT, Naik RD, Vaezi MF. Clinical management of achalasia: current state of the art. Clin Exp Gastroenterol. 2016 Apr 4;9:71-82.
- ↑ Nassri A, Ramzan Z. Pharmacotherapy for the management of achalasia: Current status, challenges and future directions. World J Gastrointest Pharmacol Ther. 2015 Nov 6;6(4):145-55.