Diagnosis
Achalasia
Failure of the lower portion of the esophagus to relax during swallowing.
Also known as: Achalasia cardia, Cardiospasm, Dyssynergia esophagus, Esophageal achalasia, Esophageal aperistalsis, Megaesophagus
Etiology
Cause [vru]
Degeneration of the myenteric plexus and vagus nerve fibers of the lower esophageal sphincter
Unknown cause
Possible theories: autoimmune phenomen, viral infection, and genetic predisposition
Pathophysiology [vru]
Gradual neural degeneration directly results in excessive contractions of the lower esophageal sphincter and peristalsis dysfunction in the esophagus.
Complications [vru]
Esophageal perforation
Gastroesophageal reflux disease
Aspiration pneumonia
Potential cancer risk
Epidemiology
Incidence per 100.000 [5s5][dfq][vru]
Prevalence per 100.000 [5s5][dfq][vru]
Symptoms & findings
Symptoms
Anorexia, Cough, Dysphagia, Globus sensation, Halitosis, Regurgitation, Weight loss
Clinical findings
Air-fluid level, Dilated esophagus, Gastrointestinal obstruction
Anamneses
None listed.
Localized findings
Approach
Barium enema
Esophageal manometry
Gastroscopy
Biopsy
Treatment
Pharmacotherapy: [vru]
Nitrates
Calcium channel blockers
Procedures: [vru]
Pneumatic dilation
Botulinum toxin
Surgical Heller myotomy
Endoscopic myotomy
Differential diagnoses
Esophageal cancer, Esophageal diverticula, Esophageal hiatal hernia, Esophageal perforation, Esophageal spasm, Esophageal stricture, Gastroesophageal reflux disease, Myocardial infarction, Scleroderma
References
[1] Momodu II, Wallen JM. Achalasia. Updated 2023 Jul 31: https://www.ncbi.nlm.nih.gov/books/NBK519515/
[2] Boeckxstaens GE, Zaninotto G, Richter JE. Achalasia. Lancet. 2014 Jan 4;383(9911):83-93. doi: 10.1016/S0140-6736(13)60651-0. Epub 2013 Jul 17. PMID: 23871090.
[3] Wadhwa V, Thota PN, Parikh MP, Lopez R, Sanaka MR. Changing Trends in Age, Gender, Racial Distribution and Inpatient Burden of Achalasia. Gastroenterology Res. 2017 Apr;10(2):70-77.