Achalasia of the esophagus - a disease characterized by the absence of reflex opening of the cardia in swallowing. The disease is accompanied by a decrease in the tone of the thoracic esophagus and intestinal motility disorders.
Disease was first described in 1672. According to statistics, the disease affects 1 person out of 100 thousand. The most frequently encountered oesophageal achalasia aged 40-50 years. Achalasia of the esophagus in children - a rare phenomenon and is approximately 3, 9% of all cases. Women tend to suffer from the disease in some times more often than men.
The most common causes of achalasia
The exact cause of contributing to the emergence of oesophageal achalasia is unknown. The most common causes include infections, external compression of the esophagus, inflammatory processes, malignant tumors, infiltrative lesions, etc.
In children, achalasia of the esophagus is most often diagnosed after the age of five. On the appearance of the first symptoms, usually no one is paying much attention, so the disease is diagnosed late. The most common symptoms of esophageal achalasia in children are dysphagia and vomiting immediately after eating.
The most characteristic symptoms of achalasia
Dysphagia is the main symptom of achalasia. Dysphagia occurs in almost all patients with the disease. Typically, the time interval between the onset of the first signs of the disease and the time to see a doctor ranges 1-10 years.
The second most common symptom of achalasia is regurgitation of food residues without admixture of acidic gastric juice and bile as a result of stagnation of the contents in the esophagus. This leads to the fact that the patients often experience nighttime asthma or cough.
Symptoms of achalasia also include heartburn and chest pain. Pain is localized mainly in the chest, wear constricting or compressing and often give in the back, jaw or neck. Sometimes, if heartburn instead of esophageal achalasia patient misdiagnosed, such as gastro-esophageal reflux. However, no heartburn in achalasia postprandial and subsides when applying antacids.
Complications of achalasia of the esophagus
Achalasia of the esophagus leads to irreversible changes in the nervous and other body systems.
The most common complications of the disease are:
- purulent pericarditis;
- squamous cell carcinoma of the esophagus;
- Bezoars esophagus;
- Peel submucosal layer of the esophagus;
- lung disease;
- voluminous education neck
- esophageal varices;
- diverticula of the distal esophagus;
- pnevmoperikard et al.
When long-existing esophageal achalasia inclined to expand substantially, leading to a thinning of its walls, thus causing the above complications of the disease.
Approximately 85% of patients with achalasia has been a significant decrease in body weight.
Diagnosis of esophageal achalasia
At different stages of achalasia cardia obstruction there is only a negligible dilation of the proximal part. With progression of the disease can be seen on X-rays characteristic features: the expansion of the esophagus, in the lower part of the clinical restriction to a small extent from the coracoid extension on the site of a narrowed department. Despite the fact that the clinical picture rather typical, frequently in patients over the age of 50 years, it may be confused with esophageal cancer, particularly in its early stages.
The greatest benefit in the diagnosis of achalasia has esophagoscopy. Confirmation of the clinical manifestations of achalasia is the study of the motor function of the esophagus. The esophagus is detected low pressure dilatation of its lumen and absence of peristalsis after swallowing. Throughout the esophagus after swallowing takes pressure rise. During swallowing esophageal sphincter does not reveal that allows to talk about the accuracy of the diagnosis of achalasia.
Some patients with motility disorders of the esophagus becomes diffuse spasm, and in response to the act of swallowing occurs again strong spasms.
Treatment of achalasia
Achalasia of the esophagus is very poorly to medical treatment. Drug treatment of achalasia used except to relieve symptoms of the disease. The patient is administered a sparing diet, sedatives, vitamins, antispastiki. Typically, drug therapy brings only temporary relief.
The accelerated expansion of the cardia is possible due to the application of mechanical, pneumatic or hydrostatic dilator. The most widely used pneumatic dilator as the safest.
Under X-ray control is introduced into the stomach tube with a balloon on the end. The lumen of the stomach balloon is inflated with air and is drawn out. This allows you to expand the lumen of the esophagus. Gaps or mucosal wall of the esophagus may occur when using elastic dilator about 1%, whereas the use of mechanical percentage increases to 6. Approximately 80% of the dilatation has a positive effect successfully rids the patient of symptoms of painful achalasia.
If the dilation does not give a positive result can be applied surgical treatment of achalasia. The most common modern surgical treatment of achalasia of the esophagus is a two-way kardiomiotomiya. The operation consists of a longitudinal incision muscle layers of the distal esophagus. Sometimes it is enough only kardiomiotomii front.
After this operation, approximately 90% are cured patients. Unsatisfactory results are mainly associated with scarring in the long-term period. This operation is the preferred method of treatment of esophageal achalasia in children in advanced stages.