Achalasia of the esophagus clinic diagnostics treatment. Achalasia cardia

Achalasia of the esophagus is a pathological condition characterized by a violation of the motor function of the esophagus, an inflammatory process, dystrophic changes in the walls of the organ and the appearance of scars on them.

This pathology has another name - achalasia of the cardia, since the opening that connects the esophagus and the stomach (cardia) is damaged.

Causes

Until now, experts cannot name the exact causes of the pathology. However, there is an opinion that cardiospasm of the esophagus develops as a result of disturbances in the work of the muscle and nervous tissue of the organ.

That is why frequent stressful situations and depressive conditions are among the factors provoking the disease.

Among the possible causes of achalasia, doctors distinguish:

  • pathology of infectious etiology;
  • viral diseases;
  • lack of B vitamins in the body;
  • poor and improper nutrition;
  • violation of the innervation of the organ.

Pathology can develop due to defects in the nerve plexus of a congenital nature.

The disease is also considered a complication of oncological processes in the body. Lupus erythematosus and polymyositis provoke the onset of the disease.

Symptoms of the condition

The main signs of the disease include:

  • impaired swallowing (dysphagia);
  • night cough;
  • nausea;
  • suffocation;
  • heartburn;
  • bad odor from the mouth;
  • belching;
  • increased salivation;
  • violation of appetite;
  • sleep disorder;
  • throwing food from the esophagus into the pharynx (regurgitation).

Often, patients with this diagnosis complain of chest pain. Such sensations can be given to the scapula, shoulder, jaw or neck. In case of pathology, gastric juice can be thrown into the upper esophagus..

If such symptoms are observed, it is important to consult a gastroenterologist who will confirm or deny this diagnosis.

This disease should not be confused with chalasia. The differences between these pathologies are that in the first case, there is a violation of the opening of the cardia (sphincter), in the second - a failure in its closure.

With chalasia, prolonged vomiting, heartburn and aching pain in the stomach or in the solar plexus zone usually occur.

Features of the disease at a young age

In children, the disease develops extremely rarely. Usually pathology occurs after the age of five. Manifested by vomiting during or after eating food.

Children often suffer from bronchitis and pneumonia in the presence of this ailment. There is a cough that occurs at night, regurgitation.

The disease in childhood is characterized by dysphagia. Often, against the background of pathology, anemia develops, a delay in physical development is possible as a result of impaired nutrition.

In infancy, the manifestation of esophageal achalasia is also possible. With illness in newborns during breastfeeding, vomiting begins, and the frequency of regurgitation increases. Vomit has the appearance of undiluted milk with no gastric juice.

Diagnostic methods

Symptoms of the disease can be confused with symptoms of other pathologies of the digestive system. That is why the patient is required to undergo a mandatory examination. For diagnostics, the following diagnostic methods are prescribed:

  • X-ray. It is possible to determine the radiological signs of the disease using a contrast agent (barium).
  • Fibrogastroduodenoscopy. The esophagus and stomach are examined using an endoscope.
  • Manometry. This method allows you to establish the state of various parts of the esophagus during swallowing.

In addition, a chest x-ray is taken. Also shown are laboratory methods for the study of blood and urine.

Classification of pathology

There are 2 types of achalasia, depending on the main reason for its development:

  • Idiopathic (primary). It occurs as an independent disease.
  • Symptomatic (secondary). It develops as a symptom of various diseases.

Experts distinguish four stages of the disease according to their characteristic signs:

  • The first... The lower esophageal sphincter relaxes when swallowing, its basal tone increases to a moderate degree. As a result, food does not pass well through the esophagus.
  • The second... There is a constant increase in the basal tone of the esophageal sphincter, and the organ itself expands.
  • Third... The distal region of the esophagus begins to scar, which causes stenosis and expansion of the parts of the organ that are above this zone.
  • Fourth... The narrowing in combination with enlargement and scarring is more pronounced. At this stage, complications of esophageal achalasia develop.

Depending on the degree of the disease, appropriate treatment is prescribed. It can be conservative or surgical. The main goal is to normalize the motor function of the esophagus.

Drug treatment

In the initial stages of the disease, with unexpressed symptoms, medication is prescribed. In case of a disease, the following groups of drugs are used:

  • Nitrates (Isosorbide dinitrate, Nitroglycerin). These funds help to improve esophageal motility.
  • Calcium channel blockers (Nifedipine, Verapamil). They are appointed more often. The drugs of this group help to relax the musculature of the organ.
  • Antispasmodics (Galidor, No-shpa, Papaverine). They help relieve cardiospasm and reduce pain.
  • Prokinetics. Used for normal motor function. These include medications such as Ganaton and Motilium.

Also, in some cases, antacids and sulfates are used..

The tablets help to temporarily relieve symptoms. If medications do not help, then surgical treatment is prescribed.

Surgical method

In the first and second stages, bougienage of the esophagus is usually prescribed using an endoscope. This treatment is quite effective, but sometimes complications develop, for example, organ perforation.

At the last stages, surgical intervention is used - cardiomyotomy by the laparoscopic method. If such an operation is ineffective (as a result of atony or deformation of the organ), then extirpation is done, in which the esophagus is removed. In this case, esophagoplasty of the organ is performed.

Dilation is often prescribed, in which the cardia is stretched using a special balloon. This procedure is performed several times at intervals of five or six days.

Balloon dilation can have side effects. A dangerous complication during its implementation is the rupture of the esophagus.

Alternative remedies

Alternative treatment is used as an auxiliary method. It is usually recommended to use fortifying medicines based on medicinal plants such as:

  • aloe;
  • eleutherococcus;
  • marshmallow;
  • ginseng;
  • pink rhodiola;
  • lemongrass.

Folk remedies are used to relieve symptoms such as heartburn and pain. For this, a decoction of oregano and calamus is used. Effectiveness is observed when taking funds based on St. John's wort, motherwort, valerian and sage.

Medicines that reduce the symptoms of the disease and improve the motility of the esophagus include a decoction of alder cones, an infusion of quince seeds.

Proper nutrition

Diet is considered one of the important nuances of treatment. Proper nutrition in case of illness is to avoid eating fried, fatty and spicy foods. Alcoholic and carbonated drinks are not permitted.

It is recommended to consume more juices and drinking yoghurts. For the diet, soups and low-fat broths, liquid porridge, vegetable purees, fresh vegetables and fruits will be optimal. It is better to eat the dishes grated, not too cold or hot..

Eating with this disease should be carried out in small portions, however, the frequency of eating increases - up to five to six times a day.

Eating well means chewing food thoroughly. Meals should be washed down with warm liquid. For this, plain water or tea is suitable.

Complications

Against the background of the disease, esophagitis usually occurs (an inflammatory process in the organ). A hernia in the esophageal opening is a frequent complication of this pathological condition. With late treatment of the disease in the last stages, other serious complications may develop.

Also, with pathology, the lungs are often affected, formations appear on the neck, and the mucous layer of the esophagus may exfoliate.

Achalasia of the esophagus is a rather rare pathology. It significantly impairs the patient's quality of life and leads to various complications. The disease is similar in symptomatology to other ailments. Therefore, it is important to diagnose it on time and start treatment, which consists in taking medications, folk remedies. Surgery is also indicated at some stages.

Treatment of esophageal achalasia should be comprehensive. It is aimed at relaxing the lower esophageal sphincter. This helps to improve its motor function.

If achalasia of the esophagus is observed, treatment should be carried out under the supervision of an experienced specialist. More details about what kind of disease it is and what symptoms it is characterized by is described.

Achalasia therapy consists of two directions. Uses methods of conservative therapy and surgical treatment. Conservative therapy includes the following points:

Surgical treatment is resorted to in the absence of the effect of the drug.

Drug therapy

The use of this type of treatment is possible before the formation of scars on the walls of the esophagus. Therefore, the prescription of drugs depends on the degree of change in the esophagus. Distinguish 4 degrees... With the first two, it is advisable to prescribe drugs.

Among the medicines, the following groups are prescribed:

  • representatives nitroglycerin series;
  • sedatives;
  • calcium channel blockers;
  • drugs that improve the peristalsis of the gastrointestinal tract;
  • compounds that protect the mucous membrane from inflammation.


Among the drugs of the nitroglycerin series, nitrates are actively used. These compounds affect the muscles of the esophagus. It relaxes. This reduces the symptoms of achalasia. These drugs should be taken with caution. They act not only on internal organs, but also on the walls of blood vessels. At the time of their reception, you should take a position, reclining or sitting. Under their influence, vasodilation occurs. Therefore, a headache may occur. Use half an hour before meals.

Sedatives are prescribed to normalize neuromuscular regulation. In addition, they reduce stress levels. Their purpose is due to the fact that the cause of achalasia can be prolonged stressful effects. Among them, drugs are often prescribed valerian or motherwort... It is recommended to take 1 tablet every day.

The duration of treatment depends on the severity of changes in the esophagus. The duration is determined by the doctor.


Another group of drugs that are used to treat achalasia are prokinetics... These substances contribute to the rapid evacuation of food into the stomach. They actively affect the peristalsis of the muscles of the digestive tract. That is why they are used to treat achalasia. They facilitate the passage of food and increase digestion.

Calcium channel blockers. This group is prescribed to reduce spasm in the esophagus. Thanks to this, the symptoms of esophageal achalasia subside.

For treatment, drugs are also used that protect the mucous membrane. Various gastro protectors are prescribed or proton pump inhibitors... Among them, substances based on omeprazole... It should be applied half an hour before meals.

Drug therapy is aimed at relieving symptoms. In the event that the degree of change in the mucous membrane is too pronounced, they resort to surgical treatment.


Balloon as treatment for achalasia

To relieve symptoms, the patient may be given balloon introduction... In the course of this manipulation, the narrowing of the esophagus is removed due to the introduction of air. That is, the balloon is inserted into the esophagus and inflated. This method is actively used if the disease appeared not so long ago.

Before carrying out such a procedure, certain preparation is carried out. It consists of the following steps:

This method is only effective if the illness does not last very long. The combination of drug therapy and balloon guidance achieves the best effect. If these methods do not help, then surgical treatment is prescribed.

Diet therapy

If achalasia of the esophageal cardia is diagnosed, its treatment necessarily involves a change in diet. The patient is advised to eat fractionally. The number of meals per day should not exceed five or six times. Portions should be smaller. All food should be finely chopped. Alcohol and other bad habits should be excluded.

Food should be lean and spicy. The number of water intake per day should be increased. Food should be taken with an increased volume of liquid. This promotes faster passage of food through the esophagus into the stomach.


Achalasia of the esophagus of the cardia: treatment with botulinum toxin

This method is used in patients with a first or second degree. It is aimed at reducing the tone in the lower esophageal sphincter. It is injected into the sphincter area itself. This method is used in patients for whom the introduction of a balloon is contraindicated.

Surgery

This method is used in the case of pronounced cicatricial changes.

They are shown only in critical condition. Balloon guiding procedures can be used after surgery. If achalasia of the esophagus is combined with other diseases, such as a hernia or cancer, then surgery is always resorted to.

Achalasia of cardia, esophageal achalasia, cardiospasm, hiatal spasm, idiopathic esophageal dilatation, megazzophagus

Version: MedElement Disease Handbook

Cardiac achalasia (K22.0)

Gastroenterology

general information

Short description

Achalasia(Greek - lack of relaxation) cardia- a chronic disease characterized by the absence or insufficient reflex relaxation of the lower esophageal sphincter (LES NPS (cardiac sphincter) - lower esophageal sphincter (circular muscle that separates the esophagus and stomach)
, cardiac sphincter NPS (cardiac sphincter) - lower esophageal sphincter (circular muscle that separates the esophagus and stomach)
), as a result of which there is a non-permanent violation of the patency of the esophagus caused by the narrowing of its section in front of the entrance to the stomach (called "cardia") and the expansion of the upper sections.

Achalasia is a neuromuscular disease consisting in a persistent violation of the reflex Reflex (from Latin reflexus - reflected) is a stereotypical reaction of a living organism to an irritant, which takes place with the participation of the nervous system
disclosure of the cardia when swallowing and dyskinesia Dyskinesia is the general name for disorders of coordinated motor acts (including internal organs), consisting in a violation of the temporal and spatial coordination of movements and inadequate intensity of their individual components.
thoracic esophagus. Manifesting in the fact that on the way of the food lump there is an obstacle in the form of a non-relaxed esophageal sphincter, this makes it difficult for food to enter the stomach. For example: opening can occur with additional filling of the esophagus, due to an increase in the mass of the liquid or food column and the application of additional mechanical pressure on the cardiac sphincter NPS (cardiac sphincter) - lower esophageal sphincter (circular muscle that separates the esophagus and stomach)
.
Disorders of peristalsis are expressed in erratic, chaotic contractions of the smooth muscles of the middle and distal parts of the esophagus.


rice. Achalasia of the cardia. General idea

Period of flow

There is no information about the flow period.
The clinical picture of achalasia of the cardia is characterized by a slow but steady progression of all the main symptoms of the disease.

Classification


There is currently no generally accepted classification of cardia achalasia.

There are two types of the disease.
Type 1 (subcompensated)- the tone of the walls and the shape of the esophagus are preserved.
Type 2 (decompensated)- the tone of the walls is lost, the esophagus is curved and significantly expanded.

Depending on the clinical manifestations and the presence of complications, division into several stages of the disease is also used.
Stage 1 (functional)- intermittent disturbances in the passage of food, due to short-term disturbances in the relaxation of the NPS. There is no enlargement of the esophagus.
Stage 2- a stable increase in the basal tone of the LPS, a significant violation of its relaxation during swallowing and a moderate expansion of the esophagus above the site of permanent functional spasm of the LPS.

Stage 3- there are cicatricial changes in the distal part of the esophagus, which is accompanied by its sharp organic narrowing (stenosis) and significant (at least 2 times) expansion of the overlying sections.

Stage 4- pronounced cicatricial narrowing of the esophagus in combination with its dilatation, lengthening, S-shaped deformity and the development of complications such as esophagitis and paraesophagitis.

Etiology and pathogenesis


The etiology of achalasia of the cardia is still not known.
Familial cases of the disease are observed. There is a theory of the congenital origin of achalasia of the cardia (Vasilenko V.Kh., 1976). The possibility of infectious toxic damage to the nerve plexuses of the esophagus and dysregulation of esophageal motility by the central nervous system is assumed CNS - central nervous system
.
Traditionally, it is believed that there are numerous factors contributing to the development of this pathology: psychogenic factors, viral infections, hypovitaminosis and others.
However, modern PCR studies have shown that achalasia is not accompanied by any of the known viral infections. The development of achalasia of the cardia in adulthood and old age also casts doubt on the congenital nature of the pathology. The role of the ERT is not excluded GER - gastroesophageal reflux
in the origin of the disease. There are some facts that allow discussing the autoimmune genesis of this disease (detection of antineutrophil antibodies, combination of achalasia with some HLA class II antigens).


The pathogenesis of the disease is associated with congenital or acquired intramural lesion Intramural - intramural, localized in the wall of a hollow organ or cavity.
nerve plexus of the esophagus (intermuscular - Auerbach) with a decrease in the number of ganglionic cells. As a result, the sequential peristaltic activity of the walls of the esophagus is disrupted and there is no relaxation of the lower esophageal sphincter. NPS (cardiac sphincter) - lower esophageal sphincter (circular muscle that separates the esophagus and stomach)
(NPC) in response to swallowing.
Due to a persistent violation of nervous regulation, the basal tone of the LPS increases and its ability to reflexive relaxation during swallowing decreases. Also, peristalsis is disturbed. Peristalsis (ancient Greek περισταλτικός - embracing and squeezing) is a wave-like contraction of the walls of hollow tubular organs (esophagus, stomach, intestines, ureters, etc.), which promotes the movement of their contents to the outlets
distal and middle (thoracic) esophagus - there are erratic, often low-amplitude contractions of smooth muscles.


In the final stages of the disease, cicatricial organic narrowing occurs in the area of ​​the LPS, pronounced dilatation Dilation is a persistent diffuse expansion of the lumen of a hollow organ.
above the site of narrowing, as well as lengthening and S-shaped deformation of the esophagus.

Epidemiology

Age: mostly from 20 to 60 years old

Prevalence: Rarely

Sex ratio (m / f): 0.3


Achalasia of the cardia can develop at any age, but most often occurs between the ages of 20-25 to 50-60 years.
Children make up 4-5% of the total number of patients.
The prevalence of the disease is 0.5-2.0 per 100,000 population.

Factors and risk groups


Sometimes achalasia of the cardia develops within the framework of hereditary syndromes, for example, the syndrome of three "A" ( BUT chalasia, BUT lacrimia, immune to BUT CTG), Alport syndrome, and other rare diseases.

Clinical picture

Clinical diagnostic criteria

Dysphagia, regurgitation, chest pain behind the breastbone, weight loss, cough at night

Symptoms, course


The main symptoms of achalasia of the cardia.

Dysphagia- a feeling of difficulty in passing food, "getting stuck" at the level of the pharynx or esophagus. It is the earliest and most persistent symptom of cardia achalasia (95-100% of patients).

With this disease, dysphagia has some important features:

Difficulty in the passage of food does not appear immediately, but after 2-4 seconds from the beginning of swallowing;

The delay in the food lump is felt by the patient not in the throat or neck, but in the chest;

There are no symptoms characteristic of dysphagia caused by movement disorders at the level of the pharynx (ingestion of food into the nasopharynx or tracheobronchial, which occurs directly during swallowing, hoarseness, hoarseness, etc.);
- dysphagia increases as a result of nervous excitement, fast food intake, especially poorly chewed;
- dysphagia is reduced with the use of various techniques found by the patients themselves (walking, drinking food with plenty of water, holding the breath, swallowing air, performing gymnastic exercises).

Dysphagia with achalasia of the cardia occurs when eating both solid and liquid food. This allows you to distinguish it from mechanical dysphagia caused by organic narrowing of the esophagus in cancer and stricture of the esophagus. Esophageal stricture - narrowing, reduction of the lumen of the esophagus of various nature.
, as well as other diseases in which the difficulty of passing food occurs only when eating solid food.

There is an alternative point of view, according to which dysphagia in achalasia is of the following nature: the swallowing of only solid food is disturbed, and the opposite pattern (disturbances in swallowing only liquid food) practically does not occur.

In most cases, with achalasia of the cardia, the manifestations of esophageal dysphagia gradually increase, although this process can be stretched for a rather long period.

Regurgitation(regurgitation) is a passive entry into the oral cavity of the contents of the esophagus or stomach, which is a mucous fluid or undigested food eaten several hours ago. The symptom occurs in 60-90% of patients. Regurgitation usually worsens after eating a large enough amount of food, as well as bending the trunk forward or at night, when the patient assumes a horizontal position ("wet pillow syndrome").

Chest pain(pain in the lower and middle third of the sternum) is present in about 60% of patients. They occur when the esophagus overflows with food and disappears after regurgitation or passage of food into the stomach. Pain can be associated with a spasm of the smooth muscles of the esophagus and then appear not only during meals, but also after excitement, psycho-emotional stress. The pain can be localized behind the sternum, in the interscapular space and often radiates Irradiation is the spread of pain outside the affected area or organ.
in the neck, lower jaw, etc.
As a rule, this type of pain is relieved by nitroglycerin, atropine, nifedipine, slow calcium channel blockers.

Slimming - a typical symptom, especially at 3-4 stages (with a significant expansion of the esophagus), often characterizes the severity of the course of the disease. Body weight loss can reach 10-20 kg or more. Most often, weight loss is associated with a conscious reduction in patients' food intake due to the fear of pain and dysphagia after eating.

Other symptoms
With the progression of the disease, symptoms of the so-called stagnant esophagitis may appear: rotten belching, nausea, increased salivation, bad breath (these symptoms are associated with prolonged stagnation and decomposition of food in the esophagus).

Occasionally, patients experience heartburn, caused by the processes of enzymatic breakdown of food in the esophagus itself with the formation of a large amount of lactic acid.

In patients with achalasia, hiccups occur more often than in patients with dysphagia due to other causes.

In children
Achalasia of the cardia in children is manifested by the presence of regurgitation, dysphagia when swallowing solid and liquid food, sudden vomiting without nausea before it appears, while vomit consists of unchanged food. Complaints of pain in the lower and middle third of the sternum are characteristic. Children have hiccups and belching with air, often weight loss and polydeficiency anemia. Regurgitation of food during sleep and nocturnal cough may occur, pulmonary complications are not uncommon: bronchitis and pneumonia. The appearance of such complications as esophagitis, compression of the recurrent nerve, compression of the right bronchus, compression of the vagus nerve is also possible.
Clinical symptoms of achalasia of cardia in children can appear between the ages of 5 days and 15 years (Ashkraft K.U., 1996).

Diagnostics


Physical examination
At the initial stages of the development of the disease, as a rule, it is not possible to identify significant deviations. External signs are found mainly in more severe and complicated cases - at 3-4 stages of the disease. Weight loss indicates malnutrition, decreased turgor Turgor - the tension and elasticity of the tissue, changing depending on its physiological state.
skin - for dehydration, and there are signs indicating the development of aspiration pneumonia.

Anamnesis
Achalasia is suspected when patients complain of dysphagia, chest pain after eating, frequent hiccups, regurgitation, belching and weight loss.

Instrumental research

1. X-ray of the esophagus(with its contrasting with barium sulfate).
Typical signs of the disease: an enlarged lumen of the esophagus, the absence of a gas bubble in the stomach, delayed release of the esophagus from the contrast agent, the absence of normal peristaltic contractions of the esophagus, narrowing of the terminal esophagus ("candle flame").
The sensitivity of the method is at the level of 58-95%, the specificity is 95%.

2. Gastroscopy (esophagogastroduodenoscopy (EGDS), FEGDS).
Typical signs with EGDS: weakening of the motility of the esophagus, lack of adequate relaxation of the LPS NPS (cardiac sphincter) - lower esophageal sphincter (circular muscle that separates the esophagus and stomach)
, narrowing of the esophagus in the LPS NPS (cardiac sphincter) - lower esophageal sphincter (circular muscle that separates the esophagus and stomach)
and its expansion above the point of narrowing. In the case of attachment of esophagitis, thickening of the folds, hyperemia Hyperemia - increased blood filling in any part of the peripheral vascular system.
mucous membrane, erosion and ulceration.
The sensitivity of the FEGDS for detecting alahazia is 29-70%, the specificity is 95%.

3. Esophageal manometry (esophageal manometry).
Absence or incomplete relaxation is characteristic. Relaxation, muscle relaxation (from Latin relaxatio) - weakening, relaxation
NPC NPS (cardiac sphincter) - lower esophageal sphincter (circular muscle that separates the esophagus and stomach)
at the time of swallowing, increased pressure in the area of ​​the LPS NPS (cardiac sphincter) - lower esophageal sphincter (circular muscle that separates the esophagus and stomach)
, increased intraesophageal pressure in the intervals between swallowing, various violations of the peristalsis of the thoracic esophagus (from akinesia Akinesia is the absence of active movements.
before episodes of spastic Spasmodic - occurring during spasms or resembling a spasm in its manifestation.
abbreviations).
The sensitivity of the method is 80-95%, the specificity is 95%.

4.Endoscopic examination of the esophagus.
Endoscopic signs of cardia achalasia: enlarged lumen of the esophagus and the presence of food masses in it; narrowing of the cardiac opening of the esophagus and its minimal opening when air is pumped into the esophagus; insignificant resistance when passing the endoscope tip through the opening of the cardia; absence of hernia of the esophageal opening of the diaphragm and Barrett's esophagus.

5.Additional instrumental research methods:
- ultrasound examination of the abdominal organs;
- scintigraphy Scintigraphy is a radioisotope method for visualizing the distribution of a radiopharmaceutical in an organism, organ or tissue.
esophagus;
- computed tomography of the chest organs.

Visual materials(c) James Hailman, MD)

Laboratory diagnostics


Laboratory research

Pathognomonic Pathognomonic - characteristic of a given disease (about a sign).
there are no deviations.

The following studies are recommended:
- a general blood test (with the determination of the content of reticulocytes);
- coagulogram;
- serum creatine level;
- serum albumin level;
- general urine analysis.

Differential diagnosis


Differential diagnosis is carried out with the following diseases:

1. Narrowing of the esophagus due to tumor lesions of the LPS area.
Clinical presentation is similar to that of true achalasia, but physical examination may reveal lymphadenopathy Lymphadenopathy is a condition manifested by an increase in the lymph nodes of the lymphatic system.
, hepatomegaly Hepatomegaly is a significant enlargement of the liver.
, palpable abdominal mass. Pseudoachalasia is a syndrome with similar clinical manifestations that develop in infiltrative cancer of the esophageal-gastric junction.
For differential diagnosis, FEGDS is required.

2. Gastroesophageal reflux disease. GERD Gastroesophageal reflux disease (GERD) is a chronic recurrent disease caused by spontaneous, regularly recurring discharge of gastric and / or duodenal contents into the esophagus, which leads to damage to the lower esophagus. Often accompanied by the development of inflammation of the mucous membrane of the distal esophagus - reflux esophagitis, and / or the formation of a peptic ulcer and peptic stricture of the esophagus, esophageal-gastric bleeding and other complications

The main symptoms are heartburn, burning behind the breastbone and regurgitation of acidic gastric contents. A rarer symptom is dysphagia due to complications such as peptic stricture. Peptic esophageal stricture is a type of cicatricial narrowing of the esophagus that develops as a complication of severe reflux esophagitis as a result of the direct damaging action of hydrochloric acid and bile on the esophageal mucosa.
or violations of the peristalsis of the esophagus. Difficulty swallowing is more common when dense food is swallowed while liquid food goes well. The lumen of the esophagus is not widened. In contrast to achalasia, in the upright state, the contrast does not linger in the esophagus.
EGDS can reveal erosions or changes typical of Barrett's esophagus.

3. Ischemic heart disease (Ischemic heart disease).
In terms of clinical characteristics, pain in coronary artery disease is similar to pain in achalasia, but angina pectoris is not characterized by dysphagia. Diagnosis can be complicated by the fact that achalasia pain can be relieved by nitroglycerin.
It is necessary to conduct an ECG and, if in doubt about the diagnosis, a comprehensive examination to detect myocardial ischemia.

4. Congenital membranes of the esophagus, strictures, including those caused by tumors.
Dysphagia is characteristic, primarily when eating dense food. In some cases, there is vomiting and regurgitation Regurgitation is the movement of the contents of a hollow organ in a direction opposite to physiological as a result of contraction of its muscles.
delayed esophageal contents.

5. Neurogenic anorexia.
Possible neurogenic dysphagia is usually accompanied by vomiting of gastric contents and weight loss.

6. Other diseases and factors: esophagospasm, damage to the esophagus with scleroderma Scleroderma is a skin lesion characterized by its diffuse or limited compaction with the subsequent development of fibrosis and atrophy of the affected areas.
, pregnancy, Chagas' disease (Chagas), amyloidosis, Down's disease, Parkinson's disease, Allgrove's syndrome.

Complications


According to some studies, achalasia increases the risk of developing tumors (usually keratinizing, mainly in the middle third of the esophagus) 16 times over 24 years.

Treatment abroad

Achalasia of the cardia is a neuromuscular pathology of the esophagus, which is associated with changes in esophageal peristalsis and tone.

The cardiac department performs the function of a muscle pulp. It relaxes as food moves into the stomach and closes to prevent backflow of contents into the esophagus.

The special functioning of the muscles is regulated by the autonomic nervous system. When vegetative regulation changes, its synchronous work is disturbed. Because of this, food lingers longer in the esophagus, stretching its walls. The result is an increase in lumen.

Concept

This is an ailment characterized by the absence or insufficient relaxation of the esophageal sphincter. Because of this, there is a constant violation of the patency of the esophagus. Disorders are expressed in chaotic contractions of smooth muscles. Their amplitude can be decreased or increased.

Thomas Willis was the first to write about the disease. The share of achalasia of the cardia accounts for from 3, 1 to 20% of lesions of the esophagus. About 1 case of the disease is registered per 100 thousand of the population. It is more common in people aged 41 to 50 years (22.4%). The least sick people are between 14 and 20 years old. Slightly more cases are found in women.

The ICD-10 code is K22.0.

Reasons for the appearance

There are a huge number of theories trying to establish the prerequisites for the development of the disease.

Some scientists associate the pathology with a defect in the nerve plexuses of the esophagus, secondary damage to nerve fibers, infectious diseases, and a lack of vitamin B in the body.

There is also a theory according to which the development of the disease is associated with a violation of the central regulation of the functions of the esophagus. In this case, the disease is considered as a neuropsychic trauma, which led to a disorder of cortical neurodynamics and other pathological changes.

It is believed that at the very beginning the process is reversible, but over time it develops into a chronic disease.

There is another opinion that the development of the disease is associated with chronic inflammatory diseases that affect the lungs, hilar lymph nodes, vagus neuritis.

Classification of achalasia of the esophageal cardia

There are over 25 different classifications of this disease. One of the most convenient for doctors is the division of the disease into stages:

  • At the first stage, there is a functional spasm, but there is no narrowing of the cardia and expansion of the esophagus.
  • In the second stage, the incidence of spasms increases. A blurred expansion of the esophagus appears.
  • At the third stage, cicatricial changes are formed in the muscle layers of the department. There is a pronounced expansion of the organ.
  • At the fourth stage, pronounced stenosis and significant changes in the esophagus are noted. Stagnant esophagitis with areas of dead tissue and ulceration is found.

There is a division of the disease by type. Radiological signs are the cornerstone. There are two main types:

  • The first is characterized by a moderate narrowing of the esophagus. His circular muscles are in a state of hypertrophy and dystrophy. 59% of all cases are of this type.
  • In the second type, there is a significant narrowing of the distal segment of the esophagus. Its shell changes its structure and is supplemented by layers of connective tissue. The organ can take the shape of the letter S.

The first type can be transformed into the second. Sometimes doctors talk about intermediate forms.

Symptoms

For achalasia of the cardia, the following are characteristic:

  • chest pain
  • weight loss,
  • dysphagia.

The latter is expressed in impaired swallowing of food. It occurs due to the slowing down of the passage of the shrunken person into the stomach. The features of this process are as follows:

  1. Passage is not immediately disrupted, but 3-4 seconds after the start of swallowing.
  2. At first, a sensation of obstruction occurs in the chest area.
  3. In this case, liquid food passes worse than solid food.

As a result of a violation of the natural processes of swallowing, food can enter the nasopharynx, trochea. This is a prerequisite for hoarseness, sore throat.

Another symptom is the involuntary leakage of food through the mouth. This phenomenon is more often found when eating a large amount of food, as well as when the body bends. Emerging chest pains are bursting or spastic in nature. They are associated with stretching of the walls of the esophagus.

This ailment proceeds in waves: periods of exacerbation and severe pain can be replaced by a time when the state of health is satisfactory.

Features of the disease in children

In children, the disease often develops after five years. In rare cases, doctors talk about congenital diseases. During infancy, vomiting of undigested breast milk is noted. Regurgitation occurs when the baby is sleeping, there is a night cough. Older children are worried about pain, especially in the chest area.

Such children are more likely to be infected with bronchitis and pneumonia. When examining the anamnesis, doctors often find that such babies eat more slowly, chew food. Chronic disorders can lead to developmental delays and anemia.

Complications

The main complications include the appearance of a strong narrowing of the scars of the cardia. In rare cases, the mucous membrane is malignant. Aspiration of pneumonia occurs. This is due to the ingestion of pieces of food into the respiratory tract of a person.

All this is complemented by inflammatory processes and depletion of the body. The latter is due to the minimum intake of nutrients in the body. Due to violations in the work of organs, the appearance of adhesions and is possible.

Differential diagnosis

When making an accurate diagnosis, problems often arise regarding the differentiation of achalasia and cardia.

X-ray examination reveals asymmetry of the narrowing and uneven contours. There is a violation of the relief of the mucous membrane and the rigidity of the wall.

Esophagoscopy with biopsy is critical. The material is taken for and.

The main indicator for radiological symptoms is the narrowing of the terminal esophagus. It is expanded, becomes longer and more curved. When carrying out esophagoscopy, thickened folds of the mucous membrane and areas of hyperemia, the appearance of erosions are revealed.

Often a symptom is a malfunction of the esophagus. To damage the diagnosis or in case of cardia insufficiency, pharmacological methods of manometry are used. The latter allows you to assess the state of the sphincter and muscles in the lower esophageal tube.

Treatment of achalasia of cardia

The most common treatments are medication and surgery. Drug treatment is used only in the early stages of the disease.

At the same time, the treatment has features, since patients cannot always swallow drugs successfully. If this function is disturbed, then the drugs are prescribed so that they can be absorbed under the tongue or given in the form of injections.

Such therapy is aimed at suppressing symptoms, but drug treatment is effective only in 10% of cases. Usually, such an effect is prescribed for older people who are contraindicated for surgical assistance.

The main group of drugs is represented by drugs aimed at relaxing the esophagus. These include:

  • Isosorbide,
  • Dinitrate,
  • Nitroglycerine.

This effect is supplemented by myotropic antispasmodics. The method of treatment and dosage are prescribed depending on the stage of the disease and the form, taking into account individual characteristics. Sedatives relax the muscles in the larynx.

Surgery

The most popular method is balloon dilation. This is an endoscopic method of treatment, which is based on mechanical rupture of the fibers of the lower esophageal sphincter.

Despite the fact that there are various manufacturers of cylinders, their design is the same for all. The device is a balloon catheter with a channel for a guidewire, through which it is inserted into the area of ​​the lower sphincter. All manipulations take place under X-ray control.

Before the procedure, the person does not eat for 12 hours. The intervention is carried out using the method of deep sedation and pain relief. Doctors say that the main condition for performing the manipulation is the exclusion of a malignant lesion in the area of ​​the cardia.

A balloon is held along the guide. This manipulation has only one serious complication - esophageal perforation.

Forecast and prevention

Achalasia of the cardia is a slowly progressive disease. Lack of timely treatment can lead to bleeding, violations of the integrity of the walls of the esophagus and general depletion of the body.

After the treatment, there may be a relapse in 6-12 months. Good prognostic results are observed in the absence of irreversible changes in esophageal motility.

Preventive measures are to eliminate various risk factors that can become prerequisites for the onset of the disease. Experts recommend giving up smoking and alcohol, avoiding overexertion and stress.

After the illness, various procedures are prescribed to reduce the risk of relapse.

A prerequisite is adherence to a diet. The daily diet should be divided into 5 meals, which must be chewed thoroughly. After eating, it is recommended to take a few vigorous sips of water or tea.

Video broadcast about achalasia of the esophageal cardia:

Achalasia of the esophagus is a neuromuscular disorder of the motor activity of the esophagus (peristalsis) with dysfunction of the lower sphincter, which leads to obstruction of the passage of food through the digestive tract.

Achalasia affects both men and women between the ages of 25 and 60. In Europe, this disease is diagnosed in 5-8 cases per 1 million people. World practice notes 4-6 cases per 1 million population. Achalasia of the esophagus is often also called cardiospasm or achalasia of the cardia.

Varieties of the disease

There are two main types of esophageal achalasia - the first type and the second.

The first type is characterized by the preservation of the walls and shape of the organ. The second type is characterized by a lack of tone of the esophagus, its significant increase and curvature of the shape.

There are also 4 stages of the disease:

  • initial - manifested by a narrowing of the sphincter at the bottom of the esophagus, difficulty in swallowing is rare, patients complain of burning sensation, nausea;
  • stable - manifested by a constant spasm of the sphincter at the bottom of the esophagus, the esophagus itself slightly expands, while swallowing food is difficult, patients are tormented by coughing and profuse salivation;
  • cicatricial - manifested by cicatricial changes due to food stuck and hardening, the sphincter loses its elasticity and increases significantly in size;
  • complications - manifested by a narrowing of the sphincter at the bottom, the appearance of inflammation, ulcers and tissue necrosis.

Achalasia of the esophageal cardia is a violation of the possibility of opening the cardiac part of the stomach. The cardia is a valve that protects the esophagus from accidental injections of gastric juice and food debris, that is, it separates the esophagus from the stomach. When there is a disorder in the work of intestinal motility and a decrease in the tone of the esophagus, a disease manifests itself - achalasia of the cardia. It is distinguished by a sharp and fairly rapid manifestation of all the symptoms of achalasia disease.

This type of achalasia affects people aged 40-50 years, there are also cases of the disease between the ages of 14 and 20 years.

Causes and factors of the occurrence of achalasia

The mechanism of manifestation of this disease is quite simple. The onset of the disease is accompanied by a disruption in the work of nerve cells responsible for normal peristalsis and impulses that are transmitted to the muscles of the esophagus (especially in its lower part).

Until now, the reasons have not been precisely studied, but the following factors are distinguished that provoke the disease:

  • infectious - viruses of herpes simplex, chickenpox, cytomegalovirus;
  • hereditary;
  • insufficient diet;
  • lack of B vitamins;
  • psychogenic - various psychological trauma, depression, severe stress.

Signs and symptoms of achalasia

The main signs of the disease include:

  • difficulty swallowing is the main symptom;
  • stuffing the remains of food into the oral cavity - after stagnation of food, it is possible without admixture of bile and juice;
  • - manifests itself mainly after the gastric juice is thrown into the esophagus and is characterized by the separation of sputum in the form of foam;
  • spitting up foam - from excessive salivation;
  • retrosternal pain is a particular sign of a pressing character;
  • heartburn.

Diagnostics

To identify the disease, methods of esophageal manometry, plain radiography, and radiopaque esophagography are used. The latter diagnostic method allows to identify the disease at an early stage and is suitable for patients with complaints of difficulty in swallowing.

Manometry makes it possible to determine the stage and distinguish achalasia from other diseases of the digestive tract.

Treatment

Treatment of esophageal achalasia is aimed at stopping manifestations and high-quality prevention of complications.

Treatment methods

There are three main methods of treatment for the treatment of esophageal achalasia - non-drug, medical and surgical.

Non-drug treatment is usually used in the early stages of the disease. This type of therapy also includes treatment with folk remedies. Basically, it is aimed at normalizing the diet and fluid intake.

The medical method consists in taking certain drugs that help to normalize the functioning of the nervous and digestive systems.

The surgical method is presented in three ways - cardiomyotomy, pneumatic cardiodilation and partial fundoplication.

Medicines and drugs

Several groups of drugs are used in drug treatment:

  • nitroglycerin - Nitroglycerin;
  • calcium blockers - Isotropin, Cordaflex, Finotropin, Cordipin;
  • nitrates - Cardiket;
  • prokinetics -;
  • sedatives - Persen.

All of them have a complex effect on the body and, in particular, on the reduction of pressure in the sphincter and esophagus.

Treatment with folk remedies

In parallel with drug treatment, traditional medicine recipes can also be used, but this type of treatment should be perceived as an additional one for a faster recovery of the body.

  • As a general tonic, tinctures of Eleutherococcus, Schisandra, and Aralia, extracts of Radiola rosea are used.
  • To relieve inflammation and during the prophylaxis period, decoctions of herbs of oregano, marshmallow root, alder cones, and quince seeds are used.
  • Herbal preparations from oak bark, walnut leaves, cinquefoil root and St. John's wort are effective.
  • Motherwort, peony tincture and valerian are used as sedative folk remedies.

Side effects

With late treatment or its absence, rapid progression of the disease is possible, which can lead to partial or complete disability.

Prevention of esophageal achalasia

As preventive measures, you can name:

  • moderate physical activity;
  • giving up all bad habits (smoking, alcohol);
  • walks in the open air;
  • if necessary, visit a psychologist.

Why is the disease dangerous?

Among the complications, the development of the following diseases is distinguished:

  • squamous cell carcinoma of the esophagus;
  • depletion of the body;
  • lung damage;
  • pneumopericardium;
  • veins of the esophagus;
  • cervical neoplasms;
  • exfoliation of the submucous layer in the esophagus;
  • bezoars of the esophagus;
  • distal diverticulum;
  • fistula of the esophagus;
  • Barrett's esophagus;
  • purulent pericarditis;
  • stridor.

Diet, nutrition

When treating and preventing achalasia of the esophageal cardia, it is important to observe the following recommendations:

  • completely remove from the diet spicy, fatty and fried foods that irritate the esophagus;
  • eat often and in small portions while drinking plenty of water with food;
  • give up any energy drinks, coffee, carbonated drinks and large amounts of sugar and carbohydrates;
  • eat only those foods that stimulate the stomach and are able to digest quickly.

Features in children

Achalasia in children is diagnosed mainly after 5 years. It is explained by the inability to relax the muscles of the esophagus. It is quite difficult to define the disease, but it usually manifests itself in the form of regurgitation, nocturnal cough and difficulty swallowing food.

If not treated, achalasia of the esophagus can lead to complications such as anemia, developmental delay, bronchitis and pneumonia.

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