Esophageal achalasia

achalasiaCardiospasmAchalasia Awareness – Martin Mueller IV Achalasia Awareness FoundationAchalasia, familial esophagealoesophageal achalasiaoesophagussphincter relaxation disorders
Esophageal achalasia, often referred to simply as achalasia, is a failure of smooth muscle fibers to relax, which can cause the lower esophageal sphincter to remain closed.wikipedia
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Dysphagia

difficulty swallowingdifficulty in swallowingtrouble swallowing
Achalasia is characterized by difficulty in swallowing, regurgitation, and sometimes chest pain.
Achalasia is a major exception to usual pattern of dysphagia in that swallowing of fluid tends to cause more difficulty than swallowing solids.

Botulinum toxin

Botoxbotulinumbotulin
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).
Similarly, botulinum toxin is used to relax clenching of muscles, including those of the oesophagus, jaw, lower urinary tract and bladder, or clenching of the anus which can exacerbate anal fissure.

Heller myotomy

Heller procedure
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).
It is used to treat achalasia, a disorder in which the lower esophageal sphincter fails to relax properly, making it difficult for food and liquids to reach the stomach.

Triple-A syndrome

Triple A syndromeAchalasia-Addisonianism-Alacrimia syndromeAAA syndrome
However, a small proportion occurs secondary to other conditions, such as esophageal cancer, Chagas disease (an infectious disease common in South America) or Triple-A syndrome.
The syndrome involves achalasia, addisonianism (adrenal insufficiency of primary type), and alacrima (insufficiency of tears).

Chagas disease

Chagas' diseaseAmerican trypanosomiasisChagas
However, a small proportion occurs secondary to other conditions, such as esophageal cancer, Chagas disease (an infectious disease common in South America) or Triple-A syndrome.
Swallowing difficulties (secondary achalasia) may be the first symptom of digestive disturbances and may lead to malnutrition.

Chest pain

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

Achalasia microcephaly

Achalasia can also manifest alongside other diseases as a rare syndrome such as achalasia microcephaly.
Achalasia, or oesophageal achalasia, is a disorder occurring in the lower oesophageal sphincter (LES).

Esophagus

oesophagusesophageallower esophageal sphincter
Esophageal achalasia, often referred to simply as achalasia, is a failure of smooth muscle fibers to relax, which can cause the lower esophageal sphincter to remain closed. Esophageal achalasia is an esophageal motility disorder involving the smooth muscle layer of the esophagus and the lower esophageal sphincter (LES).
Achalasia refers to a failure of the lower esophageal sphincter to relax properly, and generally develops later in life.

Esophageal motility disorder

esophageal dysmotilityesophageal motility disordersdisordered motility
Esophageal achalasia is an esophageal motility disorder involving the smooth muscle layer of the esophagus and the lower esophageal sphincter (LES).

Esophageal cancer

throat canceroesophageal canceresophageal
However, a small proportion occurs secondary to other conditions, such as esophageal cancer, Chagas disease (an infectious disease common in South America) or Triple-A syndrome.

Hirschsprung's disease

Hirschsprung diseaseCongenital megacolonHirschprung disease
Achalasia can happen at various points along the gastrointestinal tract; achalasia of the rectum, for instance, may occur in Hirschsprung's disease.

Peristalsis

peristalticgut motilityperistaltic contractions
It is characterized by incomplete LES relaxation, increased LES tone, and lack of peristalsis of the esophagus (inability of smooth muscle to move food down the esophagus) in the absence of other explanations like cancer or fibrosis.

Nutcracker esophagus

nutcracker achalasianutcracker oesophagus
Nutcracker esophagus is one of several motility disorders of the esophagus, including achalasia and diffuse esophageal spasm.

Esophageal motility study

esophageal manometrymanometryoesophageal manometry
Diagnosis is reached with esophageal manometry and barium swallow radiographic studies.
These include achalasia, diffuse esophageal spasm, nutcracker esophagus and hypertensive lower esophageal sphincter.

Soft diet

mechanical soft diet
After surgery, patients should keep to a soft diet for several weeks to a month, avoiding foods that can aggravate reflux.
For example, patients who need to avoid acid reflux, such as those recovering from esophageal surgery for achalasia, are also instructed to stay away from foods that can aggravate reflux, which include alcohol, caffeine, chocolate, citrus fruits, ketchup and other tomato products, mint, and spicy foods.

Esophagogastroduodenoscopy

gastroscopygastroscopeupper endoscopy
In addition, endoscopy of the esophagus, stomach, and duodenum (esophagogastroduodenoscopy or EGD), with or without endoscopic ultrasound, is typically performed to rule out the possibility of cancer.

Per-oral endoscopic myotomy

Per-oral endoscopic myotomy or POEM is a minimally invasive type of natural orifice transluminal endoscopic surgery that follows the same principle as the Heller myotomy.
The per-oral endoscopic myotomy, or POEM, is a minimally invasive surgical procedure for the treatment of achalasia wherein the inner circular muscle layer of the lower esophageal sphincter is divided through a submucosal tunnel.

Esophageal dilatation

bougiebougie dilatationdilatation
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).

Hiatal hernia

hiatus herniahernia, hiatalCongenital hiatus hernia
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.
Complications from surgical procedures to correct a hiatal hernia may include gas bloat syndrome, dysphagia (trouble swallowing), dumping syndrome, excessive scarring, and rarely, achalasia.

Nissen fundoplication

fundoplicationgas bloat syndromelaparoscopic fundoplication
A partial fundoplication or "wrap" is generally added in order to prevent excessive reflux, which can cause serious damage to the esophagus over time.
In contrast, surgery for achalasia is generally accompanied by either a Dor or Toupet partial fundoplication, which is less likely than a Nissen wrap to aggravate the dysphagia that characterizes achalasia.

Esophagectomy

oesophagectomyesophageal coloplastyoesophagoastrectomy
The esophagus should be checked every year or two with a timed barium swallow because some may need pneumatic dilatations, a repeat myotomy, or even esophagectomy after many years.
Esophagectomy is also occasionally performed for benign disease such as esophageal atresia in children, achalasia, or caustic injury.

Myenteric plexus

Auerbach's plexusmyentericAuerbach's (Myenteric) plexus
Biopsy, the removal of a tissue sample during endoscopy, is not typically necessary in achalasia but if performed shows hypertrophied musculature and absence of certain nerve cells of the myenteric plexus, a network of nerve fibers that controls esophageal peristalsis.
Achalasia is a motor disorder of the esophagus characterized by decrease in ganglion cell density in the myenteric plexus.

Gastrointestinal tract

intestinegastrointestinaldigestive tract
Achalasia can happen at various points along the gastrointestinal tract; achalasia of the rectum, for instance, may occur in Hirschsprung's disease.

Rectum

rectalrectallyrectal ampulla
Achalasia can happen at various points along the gastrointestinal tract; achalasia of the rectum, for instance, may occur in Hirschsprung's disease.

Smooth muscle

smooth muscle cellssmooth musclessmooth muscle cell
Esophageal achalasia, often referred to simply as achalasia, is a failure of smooth muscle fibers to relax, which can cause the lower esophageal sphincter to remain closed. Esophageal achalasia is an esophageal motility disorder involving the smooth muscle layer of the esophagus and the lower esophageal sphincter (LES).