Achalasia: Difference between revisions
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==Background== | ==Background== | ||
*Inability of LES to relax and loss of normal peristalsis | *Inability of LES to relax and loss of normal peristalsis <ref>Krill JT, Naik RD, Vaezi MF. Clinical management of achalasia: current state | ||
of the art. [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4831602/ Clin Exp Gastroenterol. 2016 Apr 4;9:71-82.]</ref> | |||
==Clinical Features== | ==Clinical Features== | ||
*Dysphagia | *Dysphagia | ||
*Regurgitation | *Regurgitation | ||
*Chest pain | *[[Chest pain]] | ||
**Esophageal spasm can | **Esophageal spasm can feel like tight, crushing retrosternal pain similar to ACS | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
*[[Ingested foreign body]] | |||
*Esophageal carcinoma - ''dysphagia predominantly for solid foods during initial stages'' | |||
*Reflux esophagitis - ''dysphagia results from inflammatory swelling or a fibrotic stricture'' | |||
*Pseudoachalasia - ''underlying malignancy mimics achalasia'' | |||
*Connective tissue disorders - ''e.g. systemic sclerosis'' | |||
*Esophageal spasm - ''chest pain a predominant feature'' | |||
== | ==Evaluation== | ||
*Upper GI | *Upper GI | ||
**Esophageal dilatation | **Esophageal dilatation | ||
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==Management== | ==Management== | ||
*Trial of antispasmodic for [[Esophageal Spasm]] | *Trial of antispasmodic for [[Esophageal Spasm]] | ||
**Nifedipine | **Nifedipine | ||
*Surgical intervention | *Surgical intervention | ||
**Baloon dilatation | **Baloon dilatation | ||
**Botulinum toxin injection | **Botulinum toxin injection <ref>Nassri A, Ramzan Z. Pharmacotherapy for the management of achalasia: Current status, challenges and future directions. World J Gastrointest Pharmacol Ther. [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4635155/ 2015 Nov 6;6(4):145-55.]</ref> | ||
**Myomectomy | **Myomectomy | ||
**Consider gastrostomy for frail and older patients | |||
*Patients need to eat upright at all times. | |||
*Treatment may improve dysphagia, but there is no cure and swallowing never completely normalizes | |||
==Disposition== | ==Disposition== | ||
==See Also== | ==See Also== | ||
*[[Ingested foreign body]] | |||
==External Links== | ==External Links== |
Revision as of 03:56, 19 July 2017
Background
- Inability of LES to relax and loss of normal peristalsis [1]
Clinical Features
- Dysphagia
- Regurgitation
- Chest pain
- Esophageal spasm can feel like tight, crushing retrosternal pain similar to ACS
Differential Diagnosis
- Ingested foreign body
- Esophageal carcinoma - dysphagia predominantly for solid foods during initial stages
- Reflux esophagitis - dysphagia results from inflammatory swelling or a fibrotic stricture
- Pseudoachalasia - underlying malignancy mimics achalasia
- Connective tissue disorders - e.g. systemic sclerosis
- Esophageal spasm - chest pain a predominant feature
Evaluation
- Upper GI
- Esophageal dilatation
- Birds beak sign
- Esophageal Manometry
Management
- Trial of antispasmodic for Esophageal Spasm
- Nifedipine
- Surgical intervention
- Baloon dilatation
- Botulinum toxin injection [2]
- Myomectomy
- Consider gastrostomy for frail and older patients
- Patients need to eat upright at all times.
- Treatment may improve dysphagia, but there is no cure and swallowing never completely normalizes
Disposition
See Also
External Links
References
- ↑ Krill JT, Naik RD, Vaezi MF. Clinical management of achalasia: current state of the art. Clin Exp Gastroenterol. 2016 Apr 4;9:71-82.
- ↑ Nassri A, Ramzan Z. Pharmacotherapy for the management of achalasia: Current status, challenges and future directions. World J Gastrointest Pharmacol Ther. 2015 Nov 6;6(4):145-55.