Está en la página 1de 14

ACHALASIA

Luiza Niyazmetova
August 7, 2017
WHAT IS ACHALASIA?

Primary esophageal motility disorder:

- absence of esophageal peristalsis


- impaired relaxation of the lower
esophageal sphincter in response to
swallowing
EPIDEMIOLOGY

Incidence:1.6 per 100,000/year


Male-to-female ratio = 1:1.

Occurs in adults aged 25-60 years

<5% of cases occur in children


THE ESOPHAGUS
THE LYMPHATICS INNERVATION
Vagus nerve

Cervical
sympathetic
trunk

Left
recurrent
laryngeal
nerve
3rd intercostal nerve

Cardiac plexus

3rd thoracic sympathetic ganglion

Left greater splanchnic nerve

Anterior vagal trunk

Celiac plexus and ganglia


PHYSIOLOGY OF SWALLOWING
Pharyngeal contraction
coincides with relaxation of
the upper esophageal
sphincter
This is then followed by
sequential (peristaltic)
phasic contraction along the
esophageal body, which
propels the swallowed bolus
toward stomach.
The lower esophageal
sphincter relaxes soon after
the initiation of the swallow
and remains relaxed until
the peristaltic wave arrives.

GI Motility online (May 2006) | doi:10.1038/gimo13


CAUSES OF ACHALASIA

Idiopathic
Chagas disease
Amyloidosis
Sarcoidosis
Neurofibromatosis
Eosinophilic esophagitis
Multiple endocrine neoplasia type 2B
Juvenile Sjgren syndrome
Chronic idiopathic intestinal pseudo-obstruction
Fabry disease
PATHOGENESIS OF ACHALASIA
CLINICAL PRESENTATION

Dysphagia
Regurgitation

Weight loss

Heartburn, postprandial choking, & nocturnal


coughing
DIAGNOSIS

Esophageal manometry Barium esophagram


(Incomplete relaxation of the LES in response
to swallowing, high resting LES pressure,
absent esophageal peristalsis)

Bird-beak" appearance

Endoscopic evaluation
TREATMENT
PROGNOSIS

Disease course: without treatment, patients with


achalasia can develop progressive dilation of the
esophagus

Cancer risk : patients with achalasia are at


increased risk for developing esophageal cancer
REFERENCES

Allaix. (2016). Achalasia. Retrieved from


http://reference.medscape.com/article/169974-overview

Spechler SJ. (2016). Achalasia: Pathogenesis, clinical manifestations, and


diagnosis. Retrieved from https://www.uptodate.com/contents/achalasia-
pathogenesis-clinical-manifestations-and-
diagnosis?source=search_result&search=achalasia&selectedTitle=1~95#H3553
861093

Townsend, Beauchamp, Evers, Mattox. (2017). Sabiston Textbook of Surgery,


Twentieth Edition. Copyright 2017 by Elsevier, Inc.

Vaezi MF, Pandolfino JE, Vela MF. ACG clinical guideline: diagnosis and
management of achalasia. Am J Gastroenterol 2013; 108:1238