Achalasia : Symptoms , Treatment , Definition , Causes , Diagnosis

achalasia treatment, achalasia Causes, achalasia Definition, achalasia  Diagnosis

Achalasia : Symptoms , Treatment , Definition , Causes , Diagnosis

If swallowing increasingly causes problems, so that the food gets stuck in the throat apparently , a achalasia is responsible in rare cases. This is a malfunction of the esophagus, which causes the lower esophageal muscle is not relaxed during swallowing.
Normally, nerve cells control the exact movements of the gullet ( esophagus) during swallowing - in achalasia they have failed. The feed is not fully conveyed from the mouth to the stomach. The exact causes are unknown , according to most of achalasia are considered idiopathic ( ie without known cause ) . In 2 out of 100 people with achalasia there is a familial predisposition and is approximately 1 in 100, a nerve disease ( PD ) . Most of the achalasia occurs in middle age .

The typical symptoms of achalasia are :

Swallowing,Regurgitation of food residues ( regurgitation ) andBloating .Initially, the symptoms occur only occasionally and are first mildly pronounced. Until later in the achalasia affects the everyday life of victims of disabling. With the increasingly disturbed eating process , it may cause a gradual loss of weight. Rarely, esophageal cancer ( esophageal cancer ) can hide behind the characteristic symptoms . Therefore, the symptoms are necessarily clarified by mirroring ( endoscopy ) of the esophagus.Therapy for achalasia different methods come into question. All have the same goal : by reducing the pressure in the lower esophageal sphincter to ensure that the food can quickly and completely pass from the esophagus into the stomach, and so to relieve the symptoms . With a slight achalasia sufficient medication to treat initially , but the best treatment results usually shows a widening ( dilation ) of the lower esophageal muscle. The treatment can reduce the discomfort usually satisfactory , but the cure achalasia is not.

Achalasia : Definition

The term achalasia means by definition a disorder of the esophagus that is characterized as follows :The lower sphincter ( sphincter ) of the gullet ( esophagus) is located in an elevated state of stress , so swallowing it - other than in healthy people - not relaxed.Often also the movements of the middle and lower esophagus, the chyme further transport (so-called peristalsis ) is reduced.The esophagus is a muscular tube which is lined with a mucous membrane. Within the muscle layer are networked with each other nerve cells (called the Auerbach plexus ) . You control the exact movements of the esophagus during swallowing . These movements convey the chyme completely from the mouth to the stomach. There, the acidic environment for disinfection of food ensures no sharp movements mix the food with enzymes and crush them further.The sphincter between the stomach and esophagus - the lower esophageal sphincter - prevents such a valve , that there flow back chyme and aggressive hydrochloric acid in the esophagus : It provides with muscle contraction and relaxation that swallowing the food reaches the stomach , but flowing back stomach contents can . In the achalasia of the lower esophageal sphincter can not slacken because of the Auerbach plexus has failed.Thus, the entrance to the stomach with a closed achalasia is so strong that the food can not fully reach the stomach - the bite is literally stuck in the throat. Characterized in the esophagus there is increased pressure, which will cause the esophagus widens as a result.
Achalasia is a relatively rare: It shows annually with a frequency of less than 1 new case per 100,000 inhabitants. It can occur at any age , but it occurs most often between the 20th and 40 Age on .

Achalasia : Causes

When achalasia food can not completely pass from the esophagus into the stomach. This has its origins in the fact that a network of nerves (called the Auerbach plexus ) has failed in the lower esophagus, so that the supply of the esophageal muscles is disturbed by the nerves. The result: The lower esophageal sphincter (called esophageal sphincter ) can not slacken in swallowing and the ability of the middle and lower esophagus to contract and thus to further convey the chyme (called peristalsis ) is reduced.The exact cause of this disorder of the esophagus is unknown : In 97 of 100 cases, achalasia is considered idiopathic ( ie without known cause) . In 2 out of 100 victims a familial predisposition is observed , and every hundredth achalasia caused by nerve disorders (such as Parkinson's disease) .For achalasia or other diseases as causes being: Presumably autoimmune diseases lead to the causal achalasia damage to the nerve cells. In rare cases, achalasia by a tumor of the upper portion of the stomach ( gastric cancer ) or infection with Chagas' disease , a South American tropical disease arise .

Achalasia : symptoms

A typical achalasia can cause the following symptoms :Difficulty in swallowing ( dysphagia )Sufferers have difficulty swallowing the food - it is apparently stuck in my throat . Sufferers often have to drink so that the chyme can continue to slide .Regurgitation ( regurgitation )When burping get leftovers after eating from the gullet (esophagus ) back into the mouth. In advanced stages of achalasia this happens spontaneously when the victims to lie down . By belching may also food particles enter the respiratory tract. Therefore, an advanced achalasia occasionally leads to repeated lung infections ( aspiration pneumonia ) .Feeling of fullness in the chest areaAt a special form of achalasia ( hypermotile form) with increased movements of the esophagus can occur cramping pain in the chest area , which occasionally misinterpret the victims as heart ailments.The achalasia symptoms occur only occasionally at first and are first mildly pronounced. Only in the further course of the disease they affect the daily lives of sufferers from interfering . Since achalasia disrupts the eating process , take some affected over time . Due to the longer lasting food in the esophagus , the esophagus may also become inflamed (called Retentionsösophagitis ) . Among the signs of this include pain when swallowing.

Achalasia : Diagnosis

In cases of suspected achalasia , various studies of the gullet (esophagus ) are suitable for diagnosis. These include: 


endoscopic examinationX-ray examinationmanometryEndoscopy ( mirroring)May already indicate leftovers, inflammation or a visible narrowing of the lower esophagus to achalasia. In the diagnosis of achalasia is an endoscopy , which is a reflection of the esophagus and stomach , but especially important to rule out other possible causes for the symptoms - surely exclude - such as esophageal cancer. In some cases, the doctor takes out in this study to the same tissue samples (called biopsies) in order to examine them for changes and abnormalities.X-rayThus, the X-ray examination can help diagnose achalasia , get people out of the X-ray contrast agent ( Breischluck ), which makes the course of the esophagus visible on the radiograph . In achalasia is found in the X-ray image of a tapered narrow at the transition to the stomach . Depending on the stage of the disease , the area of the esophagus is dilated above the narrow (so-called champagne glass ) .

achalasia treatment, achalasia Causes, achalasia Definition, achalasia  Diagnosis

manometry

In cases of suspected achalasia diagnosis also a manometry is helpful : Using the manometry , the doctor can measure the pressure in the esophagus. Relaxes the lower esophageal muscle ( esophageal sphincter ) when not swallowing, this speaks for achalasia. The pressure measurement allows to draw conclusions on the movements of the esophagus ( peristalsis ) . Depending on the mobility of the esophagus muscles , there are three forms of achalasia :hypermotile shape: increased peristalsishypomotile form : decreased peristalsisamotile form : no longer available peristalsis

Achalasia : treatment

In achalasia , the therapy aims to relieve the symptoms. To this end , various treatment options available . All methods have the same purpose : the pressure in the lower esophageal sphincter ( esophageal sphincter ) - valve between the stomach and esophagus - reduce . This will make it possible that food quickly and completely passes from the esophagus into the stomach.However, a causal achalasia therapy is not available : it is not possible, the cause of the dysfunction of the esophagus - the disturbed supply of the esophagus muscles by nerve - to fix. Accordingly, the achalasia is not curable.drugsIn the early stages of achalasia drugs are suitable for therapy , reduce the pressure in the lower esophagus muscle : This treatment can alleviate your symptoms adequately . The funds - calcium antagonists and nitrates, which are also used to treat high blood pressure and coronary heart disease - are taking about half an hour before eating.In the long term can be the effect of the medication after however . If drug therapy for achalasia you side effects ( such as reduction in blood pressure , dizziness, headache) causes , it also may be necessary to discontinue the medicationIn achalasia , the therapy aims to relieve the symptoms. To this end , various treatment options available . All methods have the same purpose : the pressure in the lower esophageal sphincter ( esophageal sphincter ) - valve between the stomach and esophagus - reduce . This will make it possible that food quickly and completely passes from the esophagus into the stomach.However, a causal achalasia therapy is not available : it is not possible, the cause of the dysfunction of the esophagus - the disturbed supply of the esophagus muscles by nerve - to fix. Accordingly, the achalasia is not curable.drugsIn the early stages of achalasia drugs are suitable for therapy , reduce the pressure in the lower esophagus muscle : This treatment can alleviate your symptoms adequately . The funds - calcium antagonists and nitrates, which are also used to treat high blood pressure and coronary heart disease - are taking about half an hour before eating.In the long term can be the effect of the medication after however . If drug therapy for achalasia you side effects ( such as reduction in blood pressure , dizziness, headache) causes , it also may be necessary to discontinue the medication

In achalasia , the therapy aims to relieve the symptoms. To this end , various treatment options available . All methods have the same purpose : the pressure in the lower esophageal sphincter ( esophageal sphincter ) - valve between the stomach and esophagus - reduce . This will make it possible that food quickly and completely passes from the esophagus into the stomach.However, a causal achalasia therapy is not available : it is not possible, the cause of the dysfunction of the esophagus - the disturbed supply of the esophagus muscles by nerve - to fix. Accordingly, the achalasia is not curable.

drugs

In the early stages of achalasia drugs are suitable for therapy , reduce the pressure in the lower esophagus muscle : This treatment can alleviate your symptoms adequately . The funds - calcium antagonists and nitrates, which are also used to treat high blood pressure and coronary heart disease - are taking about half an hour before eating.In the long term can be the effect of the medication after however . If drug therapy for achalasia you side effects ( such as reduction in blood pressure , dizziness, headache) causes , it also may be necessary to discontinue the medication

Achalasia : balloon

Therapy for achalasia is balloon dilation ( dilation = extension) : Here, the doctor inserts a balloon into the esophagus into the stomach. The balloon expands the narrowed at a lower esophageal achalasia muscle to mechanical.The balloon is regarded as the most effective treatment of achalasia : In most cases, improve the swallowing for months , with half of those affected even after a single treatment over the years. Then it may be necessary to repeat the dilation. Particularly in childhood and adolescence , the effect of balloon dilatation but often lasts only for a limited time .The advantage of the balloon to the treatment of achalasia , is that the procedure is performed during a mirroring of the esophagus and stomach , and no operation is necessary. However, there can be complications : It is possible that the esophageal tear in the expansion ( 3%). In rare cases ( 2-5%) could infect the chest cavity and cause inflammation of the mediastinum ( mediastinitis ) . Here to help counter antibiotics.

Achalasia : Endoscopic injection of botulinum toxin

Another possible achalasia therapy is endoscopic injection of botulinum toxin : Botulinum toxin is a specific of a bacterium , the pathogen Clostridium botulinum toxin formed . This highly toxic substance dissolves in humans from the botulism - a dangerous food poisoning . However, this poison is injected diluted in the lower esophageal muscle ( the esophageal sphincter : the valve between the stomach and esophagus ) , it blocks the nerves there, so that the closure pressure is reduced permanently. The injection takes place during a mirroring of the esophagus and stomach .This achalasia treatment achieved a temporary improvement to about 90 percent. However, the symptoms of achalasia in many cases occurred within one year after the therapy again . Endoscopic injection of botulinum toxin is less risky than the balloon and particularly suitable for older people with poor health , but statistically less successful.

operation

If the non-operative measures do not relieve your symptoms of achalasia is successful, it may be necessary for the therapy to surgery. Here, the surgeon divides the muscles of the lower esophagus from the outside (so-called myotomy ) . The procedure can be performed either through a classical incision in the abdomen ( transabdominal ) or via laparoscopy ( laparoscopy , minimally invasive surgery).All procedures for achalasia therapy, the lower the closure pressure in the lower esophageal muscle successful, can lead to aggressive gastric juice easier to flow back into the esophagus and reflux disease arises . Therefore, when the operation is often a so-called complementary fundoplication : where the operator places a ring around the upper cuff muscle stomach to prevent back flow ( reflux ) permanently.

achalasia treatment, achalasia Causes, achalasia Definition, achalasia  Diagnosis

Achalasia : History

Achalasia is a chronic course ; spontaneous healing do not occur in the disorder of the esophagus. Typically with achalasia have difficulty swallowing the slow and steady over years or decades . With appropriate therapy , however, it is usually possible to relieve the symptoms satisfactorily .Left untreated , however, an achalasia to an increasing widening ( dilation ) of the esophagus up to the so-called megaesophagus with complete loss of function of the esophagus. In addition , during the course of esophageal dysfunction ( by the typical regurgitation) to pulmonary complications or - come to an inflammation of the esophagus , which in turn can lead to ulcers or bleeding - through the longer lasting food in the esophagus .General achalasia is associated with an increased risk of cancer : a 20 -year history , the likelihood that those affected an esophageal ( esophageal carcinoma ) occurs 10 times higher than in healthy people . Therefore, regular endoscopies to control are important in the follow-up.

Achalasia : prevention

Achalasia you can not effectively prevent , because the exact cause is unknown for the impaired esophageal function. However, you can reduce the risk of some comorbidities such as inflammation of the esophagus , by example, avoid alcohol and nicotine.
In addition, it is advisable for achalasia of the esophagus can be checked regularly for follow-up endoscopy for early detection of possible late effects (especially esophageal cancer ) .