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Achalasia
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
The diagnostic features of achalasia on barium swallow are a dilated esophagus, absence of stripping waves, uncoordinated contraction, and obstruction at the gastroesophageal junction with prolonged retention of barium in the esophagus. Failure of relaxation of the lower esophageal sphincter gives rise to the classical “birdbeak” deformity of funneling and narrowing of the distal esophagus (Figure 30.2).
Paper 1
Published in Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw, The Final FRCR, 2020
Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw
The patient was originally suffering with achalasia leading to dysphagia to both solids and liquids, which can be relieved with warm fluids. Barium swallow typically causes a characteristic ‘rat-tail’ narrowing of the distal oesophagus with associated oesophageal dilatation, an oesophageal air-fluid level and tertiary contractions. Warm water can be administered during the barium study to demonstrate relaxation of the lower oesophageal sphincter. Complications from achalasia include aspiration, pneumonia, oesophagitis and also malignancy. Approximately 5% of patients with achalasia develop oesophageal carcinoma and these strictures tend to occur in the mid-oesophagus.
Rational Medical Therapy of Functional GI Disorders
Published in Kevin W. Olden, Handbook of Functional Gastrointestinal Disorders, 2020
Richard M. Sperling, Kenneth R. McQuaid
Treatment of Esophageal Motility Abnormalities A number of medical and surgical measures have been used in the treatment of patients with CPUE and esophageal motility abnormalities. Unfortunately, their use is based almost solely on anecdotal recommendations. Very few have been submitted to any controlled clinical testing. The few studies that have been reported have suffered from a number of methodological problems, including small number of patients, lack of placebo controls, limited follow-up, vague or nonvalidated symptom assessment, and variable manometric diagnostic criteria. In reviewing these studies, it may be important to distinguish studies of diffuse esophageal spasm (DES) from those of nutcracker esophagus or nonspecific motility abnormalities. The treatment of achalasia is not addressed here.
Pneumatic dilation for esophageal achalasia: patient selection and perspectives
Published in Scandinavian Journal of Gastroenterology, 2022
Abdul Mohammed, Rajat Garg, Neethi Paranji, Aneesh V. Samineni, Prashanthi N. Thota, Madhusudhan R. Sanaka
Achalasia is an idiopathic esophageal motility disorder that occurs due to the selective loss of inhibitory neurons in the myenteric plexus of the distal esophagus and lower esophageal sphincter (LES), causing an imbalance between excitatory and inhibitory activity [1,2]. It results in esophageal aperistalsis and impaired relaxation of the lower esophageal sphincter (LES). It is a rare disease with an estimated prevalence of 10.82 and incidence of 0.3–1.63 per 100,000 adults per year [3]. Clinical manifestations of achalasia include dysphagia, regurgitation, chest pain, weight loss, and aspiration pneumonia. There is no cure for achalasia, and treatment is palliative and aimed at reducing the LES pressure so that gravity can assist in esophageal emptying. Pneumatic dilation (PD) and esophagomyotomy, either laparoscopic Heller myotomy (LHM) or per oral endoscopic myotomy (POEM), is the standard treatment modalities [4,5]. Patients failing treatment or left untreated can progress to end-stage achalasia. Standard endoscopic dilators are ineffective in disrupting the muscularis propria at LES, which is needed for symptoms relief. PD is an effective option for the treatment of achalasia. The technique has evolved from the use of standard high-compliant dilators to less compliant Rigiflex dilators (Boston Scientific, Marlborough, MA).
One year comprehensive prospective follow-up of achalasia patients after peroral endoscopic myotomy
Published in Annals of Medicine, 2021
Helge Evensen, Milada Cvancarova Småstuen, Anselm Schulz, Vendel Kristensen, Lene Larssen, Jorunn Skattum, Olav Sandstad, Truls Hauge, Asle W. Medhus
Symptoms of achalasia including dysphagia, regurgitation and retrosternal pain, are together with weight loss reported as the Eckardt score (ES) [4]. The score was developed as a standardized symptom registration tool for achalasia patients treated with PD, and further validation data are limited [5,6]. In addition to the mainly symptomatic evaluation of treatment by ES, objective evaluation is warranted, but often limited [7]. Results are frequently reported retrospectively with a short minimum follow-up period and a variable follow up-rate [8]. Furthermore, previous treatment may influence outcome negatively, and it is thus of interest to estimate the outcome of POEM in patients that are treatment-naive [9,10]. Post-POEM reflux should also be addressed, since reports indicate significant reflux after POEM, albeit with a varying prevalence [11].
Non-surgical treatment of esophageal perforation after pneumatic dilation for achalasia: a case series
Published in Scandinavian Journal of Gastroenterology, 2020
Renske A. B. Oude Nijhuis, Jacques J. G. H. M. Bergman, R. Bart Takkenberg, Paul Fockens, Albert J. Bredenoord
An 80-year-old female was referred to our clinic because of long-standing dysphagia. The diagnosis of achalasia type II was established by barium esophagogram and manometry. Two weeks after a first 30-mm pneumatic dilation, the patient underwent a second dilation with a 35-mm diameter balloon. Endoscopic inspection immediately after dilation showed a 4-cm linear esophageal perforation just proximal to the gastroesophageal junction. The perforation was closed endoscopically with eight endoclips. The patient was kept nil per mouth and tube-fed. The CT study performed the next day showed localized extraluminal contrast spill just proximal of the esophagogastric junction (Figure 3). Under intravenous antibiotics, symptoms resolved swiftly. A second chest CT scan 3 days later confirmed absence of extraluminal contrast and the patient was discharged 6 days post-procedure. After 12 weeks she visited our out-patient clinic and reported complete symptom remission.