Achalasia of the esophagus - Causes, Symptoms , Treatment


1. General characteristics of the disease

2. Symptoms of esophageal achalasia in children and adults

3. stages of the disease

4. Diagnosis and treatment of achalasia

achalasia (achalasia, achalasia of the esophagus) - neurogenic disorder of the lower esophageal sphincter, in which it is completely or partially lost the ability to relax during swallowing.

General characteristics

disease When diagnosed achalasia lower esophageal (cardiac) sphincter (muscle ring) does not perform the function of the transmission of food from the esophagus into the stomach.During swallowing it relaxes, the food is retained in the esophagus, resulting in expanding the esophagus, over time, so that the propulsive loses its activity and thus the ability to push the food into the stomach.

Thus, with achalasia esophageal motility is disrupted, lowered his tone, and cardiac sphincter is totally or partially lost the ability to reflex disclosure.

is believed that the cause of the disease is a

mismatch between neural regulatory mechanisms responsible for esophageal peristalsis and the work of the lower sphincter.Achalasia of the esophagus in children is often congenital in nature and is in the genetic predisposition, it is sometimes accompanied by diseases such as the Hirschsprung's disease, Down's syndrome, Alport syndrome, and others.

good news is that achalasia a rare disease, it occurs only 3% of people with various diseases of the esophagus.With early diagnosis and proper treatment, clinical and subjective achalasia symptoms completely disappear.

Symptoms of esophageal achalasia in children and adults

for esophageal achalasia is characterized by a triad of classic symptoms: difficulty swallowing (dysphagia), reverse the movement of food to reflux into the mouth (regurgitation), and pain.

1. Difficulty swallowing occurs in humans suddenly (usually on the back of strong emotions, stress) or develop gradually.It first is episodic in nature and can be observed in response to the consumption of certain foods or be a consequence of excessive emotional excitement.Difficulties in swallowing make patients look for ways to ease their condition.Some of them hold their breath, others - prefer to drink a glass of water.This behavior can be regarded as a characteristic symptom of achalasia.

2. Reverse movement of undigested food - the second most common symptom occurrence of achalasia.It occurs as a result of food from the esophagus overflow an inability to pass into the stomach.Regurgitation is diverse: it can occur during or after a meal, it is in the form of regurgitation (stage 1-2) or in the form of copious vomiting (3-4 stage).Sometimes nocturnal regurgitation, in which the reverse movement of food occurs during sleep, which leads to its flow into the respiratory tract and cause coughing.The likelihood of regurgitation is worse when bending forward of the trunk.

3. Pain - third classic symptom of esophageal achalasia.Typically, this chest pain, radiating into the region between the shoulders, neck, jaw and even.Sometimes recurrent bouts of pain are very strong character and are associated with vneglotatelnymi contractions of the esophagus.Such an attack ends with regurgitation or passage of food into the stomach.To facilitate the state can take antispasmodic drug.In the latter stages of achalasia pain is closely related to esophageal inflammation and other complications.

patients with achalasia lose weight, their ability to work is reduced, they often suffer from bronchitis and pneumonia, they inconvenience halitosis.

Symptoms of esophageal achalasia in children do not differ from the adult symptoms.A characteristic feature of "child" achalasia - a low level of hemoglobin.

stages of the disease

Brightness display all of the above symptoms of achalasia depends on the stage of the disease.

So, on the first (primary) stage, when there is no expansion of the esophagus, and narrowing of the sphincter is a rare sporadic, everything feels a person - periodic difficulty in swallowing.

more pronounced symptoms of achalasia are present on the second (stable) phase when the esophagus slightly, but expanded, and the sphincter is in a constant state of spasm (ie, stable is not disclosed).

third stage esophageal achalasia - a stage scarring sphincter tissue.Scar tissue has elastic properties, it replaces the natural sphincter tissue, whereby it becomes inelastic and incapable inflatability.Esophagus thus have significantly expanded, extended and / or curved.

When in a pronounced constriction of the sphincter and a significant expansion of the esophagus occurs inflammation of the esophagus, necrotic ulcers on it and other complications - are diagnosed with the fourth stage of achalasia.

Diagnosis and treatment of achalasia

Diagnosis "achalasia" placed on the basis of:

  • patient complaints;
  • results contrast X-ray examination of the esophagus;
  • results esophagoscopy - endoscopic examination of the esophageal mucosa;
  • results manometry - researches, allowing to register the pressure in the esophagus.

goal of treatment of achalasia - improving the permeability of the lower esophageal sphincter.For its implementation shall apply:

1. Non-pharmacological therapy.

2. Drug therapy.

3. Balloon dilation of the sphincter.

4. The introduction of botulinum toxin into the sphincter.

5. Surgical dissection of the sphincter.Selection

oesophageal achalasia treatment depends on the stage of the disease, the patient's age, concomitant diseases, esophagus condition and other factors.

Nemedekamentoznaya therapy is accompanied by any of the following methods.Its essence is the use of therapeutic diets, as well as establishing a food person mode.Medication

achalasia efficient early in the disease and includes administration of drugs to reduce the pressure in the cardiac sphincter and sedativnymh means.Among them: drugs, nitrates (Kardiket, Nitrosorbid, nitroglycerin, etc..), Drugs, calcium channel blockers (Kordafleks, cordipin, Isoptin, finoptin et al.), Prokinetics (Motilium, Reglan, and others.), Sedatives (valerian extractand motherwort, Persians, and others.).

Ease of implementation, low trauma, low probability of complications make the method of balloon dilation (expansion) of the sphincter of the most popular method of treatment of achalasia of the esophagus in children and adults.Naturally, in this method has its drawbacks, in particular the high rate of recurrence and scar tissue changes of the cardiac sphincter.

Remedy achalasia by injection of botulinum toxin into the sphincter is possible only in the early stages of the disease.Botulinum toxin causes paralysis of the sphincter muscles and thus contributes to its disclosure.

Surgical treatment of esophageal achalasia in adults and children is fairly rare.However, this surgery can reduce the likelihood of recurrence to 3%, meanwhile, as the application of other therapies achalasia recurs more than half of patients.


This article is available exclusively in the educational purposes and is not research material or professional medical advice.

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