Esophageal disorders Benign 1 Achlasia

3. BENIGN DISORDERS

3.1 ACHLASIA CARDIA

There  is in this disorder a failure of relaxation of  the  lower

end of the oesophagus (LES).

-  The etiology is unknown.

-  There is evidence  of  vagus nerve dysfunction and an observed

   change in morphology and number of oesophageal ganglion cells

   of  Auerbach's plexus.  There is progressive dilation  of  the

   oesophagus

-  The presenting symptoms of this disorder are food sticking and

   patients using fluids to wash down the food.

-  The sticking  or dysphagia may be referred to the suprasternal

   notch and may be made worse by stress.

-  There may  also  be a complaint of regurgitation or eructation

   of foul odour.

-  In cases there is a loss of weight.

-  Pulmonary  complication occur  because of aspiration pneumonia

   and include lung abscess, bronciectasis and haemoptysis.

Diagnosis  is  established  with  a  barium  study  which   shows

dilation,  tortuosity  of proximal esophagus and bird  beak  like

narrowing  of  the terminal portion of the oesophagus Roesophagus

copy is indicated to rule out oesophagitis and carcinoma

 

 

Esophageal manometry remains best for diagnosing achalasia, absent peristalsis in the distal smooth muscle segment of the esophagus with incomplete LES relaxation. In cases of manometric finding of normal esophageal motility an aggressive search for a tumor must be undertaken.

 

 

Treatment is surgical and involves an incision into the  muscular

coat  of  the terminal portion of narrow oesophagus  leaving  the

mucosa  intact  (oesophagomyotomy) (Fig. above.   Dilation  with

hydrostatic   or  pneumatic  dilators  can  be  tried.   Use   of

nitroglycerin sublingual can provide temporary relief of swollowing

difficulty

 

 

The drugs used to treat patients with achalasia have been smooth muscle relaxatnts aimed at decreasing LES tone, are calcium channel blockers (nifedipine, verapamil), opiods (loperamide), nitrates (isorsorbide dinitrate), and anticholinergics (cimetropium bromide) pharmacotherapy is best reserved as an adjunct to other therapies.

 

Botulinum toxin (BoTox) is a potent inhibitor of acetylcholine release form presynaptic nerve terminals. Recently, BoTox endoscopically injected into the LES has been used in the management of achalasia to decrease resting LES tone.

Heartburn relieve ingesting antacid regurgitation dysphagia.

Short term treatment acid suppression regimens effectively relieve symptoms

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