Medical history (history of illness) represents an important component in the diagnosis of achalasia. Family history Social history Current anamnesis/systemic anamnesis (somatic and psychological complaints). Do you suffer from difficulty swallowing? If yes: How long have these existed? Do these exist continuously or episodically? Do you have dysphagia only with solid food or also with … Achalasia: Medical History
Infectious and parasitic diseases (A00-B99). Chagas disease (American trypanosomiasis) with megaesophagus (enlargement of the esophagus). Gastroenteritis (gastrointestinal inflammation). Mouth, esophagus (esophagus), stomach, and intestines (K00-K67; K90-K93). Other esophageal motility disorders (disorder of esophageal motility). Gastroesophageal reflux disease (synonyms: GERD, gastroesophageal reflux disease; gastroesophageal reflux disease (GERD); gastroesophageal reflux disease (reflux disease); gastroesophageal reflux; reflux esophagitis; … Achalasia: Or something else? Differential Diagnosis
The following are the most important diseases or complications that may be contributed to by achalasia: Respiratory system (J00-J99) Aspiration pneumonia (pneumonia caused by inhalation of foreign material (often stomach contents)). Mouth, esophagus (food pipe), stomach, and intestines (K00-K67; K90-K93). Retentive esophagitis (esophageal inflammation associated with bacterial colonization of food pulp in diverticula/mucosal outpouchings); represents … Achalasia: Complications
Classification of achalasia according to the “Chicago classification”. Subgroups Designation Characteristics Type 1 Classic achalasia Aperistalsis (few contractions of esophageal muscles) Type 2 Pressure increase due to contraction (contracting) of longitudinal muscles No propulsive peristalsis (form of movement directed from oral (mouth) to aboral (“away from mouth”) by muscular activity); intraesophageal pressure increase in ≥ … Achalasia: Classification
A comprehensive clinical examination is the basis for selecting further diagnostic steps: General physical examination – including blood pressure, pulse, body weight, height; further: Inspection (viewing). Skin and mucous membranes of the mouth/throat. Palpation (palpation) of the abdomen (abdomen) (tenderness?, knocking pain?, coughing pain?, defensive tension?, hernial orifices?, renal bearing knocking pain?). Health check
1st order laboratory parameters – obligatory laboratory tests. Small blood count Differential blood count Inflammatory parameters – CRP (C-reactive protein) or ESR (erythrocyte sedimentation rate).
Pathogenesis (development of disease) Primary achalasia is caused by degeneration of inhibitory neurons (nerve cells) of the myenteric plexus, also called Auerbach’s plexus. The Auerbach’s plexus is located within the muscular layer of the esophagus (food pipe). There is no relaxation of the esophageal sphincter (esophageal sphincter), which is physiologically triggered by the swallowing reflex. … Achalasia: Causes
General measures Aim to maintain normal weight!Determine BMI (body mass index, body mass index) or body composition using electrical impedance analysis. Falling below the BMI lower limit (from the age of 45: 22; from the age of 55: 23; from the age of 65: 24) → Participation in a medically supervised program for the underweight. … Achalasia: Therapy Options
Therapy goals Removal of the obstacle to passage Decrease muscle tone (muscle tension) of the esophageal muscles (muscles of the esophagus). Symptomatic therapy Therapy recommendations Note: Drug therapy of halal them plays only a very minor role. The results of drug therapy in the context of achalasia are unsatisfactory and the side effects too burdensome. … Achalasia: Drug Therapy
Obligatory medical device diagnostics. Esophagogastroduodenoscopy (endoscopy of the esophagus, stomach, and duodenum) with biopsies (tissue samples) if necessary Routine diagnostics: is not so much used to detect achalasia as: To exclude stenosis, strictures (high-grade narrowing), inflammation. To exclude a carcinoma, e.g. gastric carcinoma (stomach cancer). X-ray-pre-swallow examination of the esophagus – particularly suitable in the … Achalasia: Diagnostic Tests
The following surgical procedures are used in the treatment of achalasia: Extramucosal myotomy (muscle splitting) of the lower esophageal sphincter (UES) (Gottstein-Heller operation) – can be performed surgically or laparoscopically (laparoscopic myotomy, LHM). Indication: alternative to balloon dilatation or after several dilatations have been performed with only short-term success. Success rate: up to 90% Lethality … Achalasia: Surgical Therapy
The following symptoms and complaints may indicate achalasia: Leading symptoms Dysphagia (difficulty swallowing). Caused by muscular or neuromuscular changes in the esophagus (food pipe) Both the absorption of solid foods and liquids is difficult. Often, sufferers need to drink after eating. Retrosternal feeling of pressure / fullness (localized behind the sternum). Regurgitation (regurgitation of food), … Achalasia: Symptoms, Complaints, Signs
