A report on Dysphagia and Esophageal achalasia

The digestive tract, with the esophagus marked in red
A chest X-ray showing achalasia ( arrows point to the outline of the massively dilated esophagus )
Transhiatal oesophagectomy specimen from a patient suffering from late-stage achalasia. Diverticulum at the left lower end of the oesophagus.
An axial CT image showing marked dilatation of the esophagus in a person with achalasia.
"Bird's beak" appearance and "megaesophagus", typical in achalasia.
Schematic of manometry in achalasia showing aperistaltic contractions, increased intraesophageal pressure, and failure of relaxation of the lower esophageal sphincter.
Image of a stomach which has undergone Fundoplomy

Achalasia is characterized by difficulty in swallowing, regurgitation, and sometimes chest pain.

- Esophageal achalasia

Achalasia is a major exception to usual pattern of dysphagia in that swallowing of fluid tends to cause more difficulty than swallowing solids.

- Dysphagia
The digestive tract, with the esophagus marked in red

5 related topics with Alpha

Overall

Endoscopic image of an esophageal adenocarcinoma

Esophageal cancer

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Cancer arising from the esophagus—the food pipe that runs between the throat and the stomach.

Cancer arising from the esophagus—the food pipe that runs between the throat and the stomach.

Endoscopic image of an esophageal adenocarcinoma
Esophageal cancer (lower part) as a result of Barrettʼs esophagus
Esophageal cancer as shown by a filling defect during an upper GI series
Esophageal stent for esophageal cancer
Esophageal stent for esophageal cancer
Before and after a total esophagectomy
Typical scar lines after the two main methods of surgery
Death from esophageal cancer per million persons in 2012
Endoscopic image of Barrett esophagus – a frequent precursor of esophageal adenocarcinoma
Endoscopy and radial endoscopic ultrasound images of a submucosal tumor in the central portion of the esophagus
Contrast CT scan showing an esophageal tumor (axial view)
Contrast CT scan showing an esophageal tumor (coronal view)
Esophageal cancer
Micrograph showing histopathological appearance of an esophageal adenocarcinoma (dark blue – upper-left of image) and normal squamous epithelium (upper-right of image) at H&E staining
T1, T2, and T3 stages of esophageal cancer
Stage T4 esophageal cancer
Esophageal cancer with spread to lymph nodes
Internal radiotherapy for esophageal cancer
Self-expandable metallic stents are sometimes used for palliative care

Symptoms often include difficulty in swallowing and weight loss.

Achalasia (i.e. lack of the involuntary reflex in the esophagus after swallowing) appears to be a risk factor for both main types of esophageal cancer, at least in men, due to stagnation of trapped food and drink.

The digestive tract, with the esophagus marked in red

Esophagus

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Organ in vertebrates through which food passes, aided by peristaltic contractions, from the pharynx to the stomach.

Organ in vertebrates through which food passes, aided by peristaltic contractions, from the pharynx to the stomach.

The digestive tract, with the esophagus marked in red
The esophagus is constricted in three places.
A mass seen during an endoscopy and an ultrasound of the mass conducted during the endoscopy session.

Diseases may cause difficulty swallowing (dysphagia), painful swallowing (odynophagia), chest pain, or cause no symptoms at all.

Achalasia refers to a failure of the lower esophageal sphincter to relax properly, and generally develops later in life.

Diagram of esophageal motility study in 'nutcracker esophagus'. The disorder shows peristalsis with high pressure esophageal contractions exceeding 180 mmHg and contractile waves with a long duration exceeding 6 seconds.

Esophageal motility study

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Test to assess motor function of the upper esophageal sphincter (UES), esophageal body and lower esophageal sphincter (LES).

Test to assess motor function of the upper esophageal sphincter (UES), esophageal body and lower esophageal sphincter (LES).

Diagram of esophageal motility study in 'nutcracker esophagus'. The disorder shows peristalsis with high pressure esophageal contractions exceeding 180 mmHg and contractile waves with a long duration exceeding 6 seconds.

These include achalasia, diffuse esophageal spasm, nutcracker esophagus and hypertensive lower esophageal sphincter.

These disorders typically present with dysphagia, or difficulty swallowing, usually to both solids and liquids even initially.

Endoscopic still of esophageal ulcers seen after banding of esophageal varices, at time of esophagogastroduodenoscopy

Esophagogastroduodenoscopy

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Diagnostic endoscopic procedure that visualizes the upper part of the gastrointestinal tract down to the duodenum.

Diagnostic endoscopic procedure that visualizes the upper part of the gastrointestinal tract down to the duodenum.

Endoscopic still of esophageal ulcers seen after banding of esophageal varices, at time of esophagogastroduodenoscopy
Gastroscopy or duodenoscopy is performed for a number of indications, one of the most common being in unexplained anemia, where it is used to diagnose gastric or duodenal ulcers, among other things.
Indigo carmine staining (stomach)
Endoscopic image of adenocarcinoma of duodenum seen in the post-bulbar duodenum.
Endoscopic image of gastric antral vascular ectasia seen as a radial pattern around the pylorus before (top) and after (bottom) treatment with argon plasma coagulation
Endoscopic image of Barrett's esophagus, which is the area of red mucosa projecting like a tongue.
Deep gastric ulcer
Endoscopic still of duodenum of patient with celiac disease showing scalloping of folds.
Gastric ulcer in antrum of stomach with overlying clot due to gastric lymphoma.
Endoscopic image of a posterior wall duodenal ulcer with a clean base, which is a common cause of upper GI hemorrhage.
Endoscopic images of an early stage stomach cancer. 0-IIa, tub1. Left column: Normal light. Right column: computed image enhanced (FICE). First row: Normal. Second row: Acetate stained. Third row: Acetate-indigocarmine mixture (AIM) stained.

Dysphagia – difficulty in swallowing

Dilating or stenting of stenosis or achalasia

A drawing of a hiatal hernia

Hiatal hernia

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Type of hernia in which abdominal organs slip through the diaphragm into the middle compartment of the chest.

Type of hernia in which abdominal organs slip through the diaphragm into the middle compartment of the chest.

A drawing of a hiatal hernia
Schematic diagram of different types of hiatus hernia. Green is the esophagus, red is the stomach, purple is the diaphragm, blue is the HIS-angle. A is the normal anatomy, B is a pre-stage, C is a sliding hiatal hernia, and D is a paraesophageal (rolling) type.
A large hiatal hernia on chest X-ray marked by open arrows in contrast to the heart borders marked by closed arrows
This hiatal hernia is mainly identified by an air-fluid level (labeled with arrows).
Upper GI endoscopy depicting hiatal hernia
Upper GI endoscopy in retroflexion showing Type I hiatal hernia
A hiatal hernia as seen on CT
A large hiatal hernia as seen on CT imaging
A large hiatal hernia as seen on CT imaging

Other symptoms may include trouble swallowing and chest pains.

Meanwhile, manometry can determine the integrity of esophageal movements, and the presence of esophageal achalasia.