Approach of achalasia including Hx, Examination, DDx, Ix and Treatment

1. Achalasia o-
Is A
failure of
the Lower Esophageal sphincter (CES) 10 Relax, It's classified as Either Primary (Idio Pathic or
secondary (In The context
of
Another Diseases, the chief
complaint
in Patient
With Achalasia is DysPhagia to solid & Liquid
Retrosternal Pain and weight Loss. HYPO-motile ESOPh. Disorder is the bes Described of
Achalasia
Hyper-motile Esoph.
" ↳ DYSPhagia.
Etiology:-
*
Primary Achalasia - >
most
common "cause is unknow"
&
Secondary Achalasia Pseudo-Achalasial)-> Mechanical cause of
obstruction (5.9, Malignancy).
obstructive but
Not Achalasia Esophageal cancer
Stomach cancer
Extra-Esophageal cancer
Chagas Disease
Patho-physic 10948-
A-Clinical features
Progressive Dysphagia (first
solid than liquids
Retro-Sternal Pain or chest
Pain
wieght loss
Regurgitation
Di agnostics -
*
All Patients with suspected Alchalasia should Initially undergou
Myndo-Scopy And/or Esophageal Barium Swallowing
*
Esophageal Manometry"
confirmatory test"
*
esophagram" confirmators mole" If
Manometry and Isophasual barium sea
are
tained initially.
Esophageal Barium swallowing show
⑧
WS to Rule out Pseudo-Achala
Brid. Beak sign Dilation of x Usually Normal
: *
MaY Show Retained food in Esoph.
-
Proximal ESoPh. With stenosis of or a Resistance of LES.
the gastro-Shoph. Junction.
*
If
malignancy is suspected
stenosis biopsy and Endosc. UIS
↑reatment: -
If
a Low Surgical Risk
· Pheumatic Dilation ->
Endoscope-guided graded Dilation of
the LES.
Les myotomy seller my tongs the best
treatment
option for younger patients
in
t
If
a high surgical Risk
⑳
Botox
injection in LES"350% of
Patient
Require treatment
again within 6-12 M.
·
⑧.
.
.
.
.
Nitrates or CCB
complications:-
X Mega-ESoPhagus
n
x Phenmonia, Abscess, Asthma-ResP
. SYStem
·ess
x
↑
Risk of
ESoPh. Cancer