Achalasia: Difference between revisions
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==Background== <!--T:1--> | |||
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[[File:Gray1032.png|thumb|Posterior view of the position and relation of the esophagus in the cervical region and in the posterior mediastinum.]] | [[File:Gray1032.png|thumb|Posterior view of the position and relation of the esophagus in the cervical region and in the posterior mediastinum.]] | ||
[[File:Layers of the GI Tract english.svg|thumb|Layers of the GI track: the mucosa, submucosa, muscularis, and serosa.]] | [[File:Layers of the GI Tract english.svg|thumb|Layers of the GI track: the mucosa, submucosa, muscularis, and serosa.]] | ||
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==Clinical Features== <!--T:3--> | |||
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*[[Special:MyLanguage/Dysphagia|Dysphagia]] | *[[Special:MyLanguage/Dysphagia|Dysphagia]] | ||
*Regurgitation | *Regurgitation | ||
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==Differential Diagnosis== <!--T:5--> | |||
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*[[Special:MyLanguage/Ingested foreign body|Ingested foreign body]] | *[[Special:MyLanguage/Ingested foreign body|Ingested foreign body]] | ||
*Esophageal carcinoma - ''dysphagia predominantly for solid foods during initial stages'' | *Esophageal carcinoma - ''dysphagia predominantly for solid foods during initial stages'' | ||
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==Evaluation== <!--T:7--> | |||
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*Upper GI | *Upper GI | ||
**Esophageal dilatation | **Esophageal dilatation | ||
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==Management== <!--T:9--> | |||
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*Trial of antispasmodic for esophageal spasm | *Trial of antispasmodic for esophageal spasm | ||
**[[Special:MyLanguage/Nifedipine|Nifedipine]] | **[[Special:MyLanguage/Nifedipine|Nifedipine]] | ||
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==Disposition== | |||
==Disposition== <!--T:11--> | |||
==See Also== | ==See Also== <!--T:12--> | ||
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*[[Special:MyLanguage/Ingested foreign body|Ingested foreign body]] | *[[Special:MyLanguage/Ingested foreign body|Ingested foreign body]] | ||
==External Links== | |||
==External Links== <!--T:14--> | |||
==References== | ==References== <!--T:15--> | ||
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<references/> | <references/> | ||
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[[Category:GI]] | [[Category:GI]] | ||
</translate> | </translate> | ||
Latest revision as of 16:54, 6 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.