Achalasia

Posted by e-Medical PPT Saturday, August 7, 2010
Achalasia is an esophageal motility disorder involving the smooth muscle layer of the esophagus and the lower esophageal sphincter (LES).It is characterized by incomplete LES relaxation, increased LES tone, and aperistalsis of the esophagus.
The most common form is primary achalasia, which has no known underlying cause. It is due to the failure of distal esophageal inhibitory neurons. However, a small proportion occurs secondary to other conditions, such as esophageal cancer or Chagas disease.
The main symptoms of achalasia are dysphagia and regurgitation of undigested food. Dysphagia tends to become progressively worse over time and to involve both fluids and solids. Some achalasia patients also experience weight loss, coughing when lying in a horizontal position, and chest pain which may be perceived as heartburn. The chest pain experienced, also known as cardio spasm and Non Cardiac Chest Pain (NCCP) can often be mistaken for a heart attack.Due to the similarity of symptoms, achalasia can be mistaken for more common disorders such as gastroesophageal reflux disease (GERD), hiatus hernia, and even psychosomatic disorders. 
Specific tests for achalasia are barium swallow and esophageal manometry.Various treatments are available, although none cure the condition. Certain medications or Botox may be used in some cases, but more permanent relief is brought by esophageal dilatation and surgical cleaving of the muscle (Heller myotomy).

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