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Back to Topics<<<< It is considered as the most common motility disorder of the esophagus. The reason is the inability of the relaxation of the distal sphincter (cardioesophageal sphincter). Incidence is 6 in 100,000 of population per year. Enlargement of the cardiac sphincter is the motility disorder for whole length of esophagus. Pathogenesis: Pathogenesis of achalasia is presumed to be a neurogenic degeneration (either idiopathic or infectious). The reason is dystrophic changes in the submucous nerve plexus such as Aurbach’s and Meisseners plexus. In an experiment on animals it has been relieved that the disease is caused by destruction of nucleus Ambigius and the dorsal motor nucleus of the vagus nerve. The degeneration results in hypertension of the Lower Esophageal Sphincter (LES), elevation of intraluminal esophageal pressure and the loss of progressive peristaltic movements in the body of the esophagus. Dystrophic and atropic changes occur in the muscular wall of esophagus and as a result the enlargement of the esophagus occur. Main symptom is dysphagia and dull pain occurs later on. Esophageal vomiting also occurs while the patient is in the sleeping position. This condition is known as wet pillow syndrome. Diagnosis: Diagnosis should be stated on the basis of clinical evidences and X-ray examinations. Typical sign shown by X-ray is beak like (flame like) narrowing of the distal part of esophagus and the barium contrast. Treatment: In the initial stages, the drug therapy is preferred, which include:
Hillar type of operation must be performed. It is the longitudinal incision (and commonly the muscular layer) till the mucous layer. This is called the relaxation incision. As a result of this, mucous layer is prolapsed and dilate the narrowed area. Complications: Complication of the operation is insufficiency of the cardiac sphincter. To avoid this complication, we need the Funduplication where the fundus part of the stomach is covered like cuff around the distal part of the esophagus. This article has been written by Dr. M. Javed Abbas. If you have any comments please do not hesitate to sign my Guest Book. 20:59 21/12/2002 |