DEFINITION
Achalasia (also known as kardiospasme, aperistaltik
esophagus, or megaesofagus) is a disorder in which the rhythmic contractions of
the esophagus is greatly reduced, the lower esophageal sphincter relaxation can
not be normal, and the lower esophageal sphincter pressure at rest increased.
CAUSE
Achalasia caused by malfunctioning of the nerves that
regulate rhythmic contractions of the esophagus. The cause of the nerve
dysfunction is not known for certain, but it may be due to a viral infection.
Certain tumors can also cause achalasia is due to narrowing of the lower
esophageal sphincter or esophageal nerve infiltration by the tumor cells.
Chagas disease can also cause achalasia by damaging nerve cells.
SYMPTOMS
Achalasia can occur at any age, but usually between the ages
of 20-60 years and grow gradually within a few months or years.
Lower esophageal sphincter tight causing part of the
esophagus above it becomes very wide. Esophageal dilation was instrumental in
the onset of various symptoms, among others:
·
Difficulty swallowing solid foods and liquids
·
Chest pain, can occur when swallowing or
suddenly for no apparent reason
·
Reversal of soft foods and acidic from the
esophagus dilated (regurgitation). Some patients may experience regurgitation
of undigested food during sleep. The food turned out it can get into the
respiratory tract and lungs, causing coughing, infections of the respiratory
tract, or aspiration pneumonia.
·
Weight loss
DIAGNOSIS
Several tests that can be done include:
·
X-ray examination using barium
·
Examination pressure in the esophagus
(esophageal manometry).
·
Endoscopy, to see the inside of the esophagus.
·
Biopsy can be done during endoscopy, namely by
taking a sample of esophageal tissue for examination under a microscope. This
check is useful to ensure that the existing symptoms are not caused by cancer
in the lower esophagus.
·
CT scan of the chest and abdomen, can be done to
diagnose the cancer is located in the border area of the stomach with the
esophagus.
TREATMENT
There is no way that could restore esophageal peristalsis.
The goal of treatment is to address existing symptoms by reducing pressure on
the lower esophageal sphincter.
Handling can be done such as:
·
Treatment to relax the esophageal sphincter, among
others, by the injection of botulinum toxin into the lower esophageal
sphincter. This action can successfully cope with symptoms in approximately
70-80% of patients, but improvement may only last for 6 months - 1 year.
·
Dilates the esophageal sphincter mechanically,
for example by developing a balloon inside the esophagus. This action can help
approximately 85% of patients, but it may need to be done repeatedly. However,
esophageal tears can occur in less than 2% of patients. Surgery should be done
when a tear occurs.
·
Surgery, can be done if other therapies are not
successful. Surgery is performed by cutting the muscle fibers in the lower
esophageal sphincter.
REFERENCE
- D, Michael C. Abnormal Propulsion of Food. Merck Manual
Handbook. 2007.
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