esophageal achalasia - a violation of esophageal motor activity.
evidence
Swallowing disorder - the most characteristic feature, identify virtually all patients with achalasia of the esophagus.
The second most frequent indication - casting food residues without admixture of bile acid and gastric juice into the mouth cavity due to stagnation of the contents in the esophagus.
Patients often wake up at night by coughing or choking episodes occur after casting food. Burp liquid may be white foamy mass (possibly due to the accumulation of saliva into the esophagus during sleep).
Chest pain and heartburn occur with similar frequency (approximately 40% of patients). Pain is usually localized behind the breastbone, are compressing or squeezing the nature and spread to the neck, jaw, or back.
Most patients with esophageal achalasia swallowing disorder occurs when receiving both solid and liquid food. However, at the initial stage of achalasia, dysphagia generally observed when receiving only solid food; in the later stages of the disease also joins swallowing disorder when receiving fluids.
In patients with esophageal achalasia progressively increasing the time spent on a meal. Such patients are washed down with plenty of liquid food to improve esophageal emptying.
Complications of esophageal achalasia
- esophageal bezoar
- Diverticula of the distal esophagus
- esophageal squamous cell carcinoma
- Esophageal varices
- Esophago-pericardial fistula
- Bulk formation of neck (neck-like bull frog)
- Pnevmoperikard
- lung
- Barrett's esophagus
- Stridor obstructive upper airways
- Flaking submucosal layers of the esophagus
- Purulent pericarditis.
Some of the possible complications are the result of accumulation in the esophagus immobilized residues of food and secretion of esophageal glands.
When long-existing esophagus achalasia can significantly expand.
Bulk formation stridor neck or may result from local compression of the upper respiratory tract.
Esophageal wall thinning that occurs during its expansion, is a predisposing factor occurrence of breaks, peeling submucosal layer of pnevmoperikarda, purulent pericarditis or the formation of fistulas.
Diagnostics
- Radiopaque esophagographic often performed early in the evaluation of patients with suspected esophageal achalasia and is the method of choice in patients with impaired swallowing;
- Review chest X-ray;
- Upper endoscopy;
- Esophageal manometry confirms the diagnosis of achalasia and allows you to clearly differentiate it from other disorders esophageal motor activity.
esophageal achalasia treatment
Treatment of patients with oesophageal achalasia includes
- drug therapy,
- Pneumatic balloon dilation of the lower esophageal sphincter,
- surgical dissection of muscle and vnutrisfinkternoe administering drugs.
Preparations for the pneumatic expansion take 12-16 hours. It should prophylactic antibiotics, t. K. A more than 50% of patients after expanding the esophagus in the blood fall microbes due to thinning of the wall of the esophagus.
The procedure begins with endoscopy, in which of the esophagus and the stomach is removed accumulated secret that reduces the risk of flooding. Once installed quickly inflate the balloon with air and kept in this position for 60 seconds. Today, most experts prefer to carry out the expansion of the lower esophageal sphincter gradually, using several cylinders with a diameter of 3 to 4 cm. Initially, the smallest of them is introduced; cylinder diameter is gradually increased in accordance with the result.
Frequency good results pneumatic expansion esophageal achalasia varies from 86 to 100%.
The purpose of the pneumatic dilation - performing controlled rupture of muscles of the lower esophageal sphincter. Unpleasant but predictable complication of this manipulation is the rupture of the esophagus. esophageal perforation frequency ranges from 0 to 4%.
Most often for the treatment of achalasia of the esophagus using a modified Heller myotomy for that It is to perform a single front-side of the lower esophageal muscle longitudinal section sphincter.
Studies have shown that nifedipine and isosorbide dinitrate reduce the severity of symptoms of esophageal achalasia. Upon receiving these drugs improved esophageal emptying. Clinical experience shows that drug therapy should be considered only as a preparatory measure before a more radical intervention.
