CLINACASE

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ID: 145
Category: Gastroenterology and Hepatology
CreatedBy: 1
UpdatedBy: 1
createdon: 09 Feb 2023
updatedon: 24 May 2023

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Author: Khoa Tran
Published Feb 09, 2023
Updated May 24, 2023

Table of contents

Achalasia

Etymology and Pronunciation

achalasia (uh-kay-lay-zhuh)
a- - Greek prefix for "deprive" or "without" or "from, away from, off"
khalasis - Greek for "lack of relaxation"

History of Achalasia

In 1805, Philip Bozzini made the first attempt to observe the human body directly using a tube called a Lichtleiter (German word meaning "light guide").

In 1853, Antoine Jean Desormeaux developed the endoscope, a specialized instrument for examining the urinary tract and bladder. But it wasn't used to examine the esophgus.

In 1868, Dr. Adolph Kussmaul successfully looked inside a living human stomach using a metal tube on a sword-swallower.

In 1878, Max Nitze and Josef Leiter invented a cystourethroscope for examining the urinary tract, while Johann von Mikulicz and his team created the first rigid gastroscope for practical use.

In the early 20th century, it was discovered that the esophagus had two types of muscles: smooth muscle at the top and skeletal muscle at the bottom. Furthermore, the nerves that controlled these muscles were part of the autonomic nervous system, which controls involuntary functions.

During that time an instrument called a dilator was used to treat achalasia. The dilator was passed through the patient's mouth and used to stretch the lower esophageal sphincter (LES). But this was an invasive and risky procedure.

One of the measuring tool at the time used was called esophageal manometry, a diagnostic technique that uses a catheter with pressure sensors to evaluate the esophageal muscles and sphincters.

In 1672, Sir Thomas Willis gave a name to the condition and treated it by dilating the affected area using a sponge and a whale bone. He called it "cardiospasm".

In 1922, the American physician-microbiologist, Arther F. Hurst made a significant discovery that the problem in this condition was the inability of the lower esophageal sphincter (LES) to relax. He named the condition "achalasia," derived from the Greek word "khalasis," which means "relaxation". 

In 1932, Dr. Rudolph Schindler invented a flexible gastroscope that allowed examinations even when the tube was bent.

In 1960s, Glassfiber, a new material, attracted attention in various industries, including the development of endoscopes.

In 1964, The first gastrocamera with a fiberscope, equipped with a camera, was invented.

In 1975, Gastrocameras were completely replaced by fiberscopes.

Later, Ultrasonic endoscopes were also developed, enabling examination of the surface and layers beneath the gastrointestinal tract.

With the advent of these diagnostic tools, the underlying mechanism of achalasia was eventually discovered. It was found to be caused by damage or dysfunction of the nerves in the esophageal muscles and sphincters that control swallowing. 

Today, achalasia can be successfully treated using endoscopic techniques such as balloon dilation or surgery, which were made possible by the advancements in technology developed to diagnose the condition.

Modern Understanding of Achalasia

Achalasia is a condition that affects the movement of the esophagus (the tube that carries food from the mouth to the stomach). It is not very common and can happen to anyone, without any preference for a particular gender. People with achalasia have a problem with the lower esophageal sphincter (LES), which doesn't relax properly, and their esophagus doesn't contract normally. This creates a blockage at the point where the esophagus meets the stomach.

The most common symptoms of achalasia include difficulty swallowing, chest pain, regurgitation, and weight loss. These symptoms can be mild or severe and can worsen over time if the condition is left untreated.

Causes of Achalasia

The root cause of achalasia is not fully understood, but it is believed to be caused by damage to the nerves in the esophagus or a malfunctioning of the muscles that help the esophagus function properly.

Some factors that may contribute to the development of achalasia include genetics, viral infections, and autoimmune disorders. In some cases, achalasia can be triggered by a traumatic injury, radiation therapy, or certain medications.

Other medical conditions, such as gastroesophageal reflux disease (GERD), Chagas disease, or a condition called diffuse esophageal spasm, can also cause achalasia. Obesity and smoking are also known to be risk factors for developing the condition.

While the precise causes of achalasia are not fully understood, research continues to shed light on the underlying factors that contribute to this challenging condition. Individuals who experience symptoms of achalasia should speak with a healthcare provider to explore their treatment options.

Treatments for Achalasia

Treatment for achalasia often involves procedures to help the muscles of the esophagus relax and allow food to pass through into the stomach. This can include medications to help relax the muscles, or procedures such as balloon dilation or surgery to widen the esophagus. In some cases, a feeding tube may be necessary.

Achalasia is a medical condition where the muscles in the lower part of your esophagus don't relax properly, making it difficult to swallow properly. There are treatments available for this condition, and the type of treatment chosen is based on the patient's individual symptoms and the severity of the condition.

One common treatment option for achalasia is medication. Certain medications that help to relax the esophageal muscles can be prescribed to alleviate symptoms such as difficulty swallowing or regurgitating food. However, medication typically only provides temporary relief and may not be a long-term solution.

Another treatment option for achalasia is endoscopic therapy. This involves the use of a special tube with a camera and instruments attached to it that is inserted through the mouth and down into the esophagus. The instruments can be used to stretch or dilate the esophagus, which can help to relieve symptoms.

Surgery may also be an option for some patients with achalasia. There are various types of surgeries available, such as the Heller myotomy, which involves cutting the muscles in the lower esophagus to make it easier to swallow.

Finally, lifestyle changes such as eating smaller, more frequent meals, chewing food thoroughly, and avoiding foods that trigger symptoms can also help to manage symptoms of achalasia. It's important to speak with a doctor or specialist to determine the best treatment plan for your individual needs.

Lifestyle Changes

While there is no known cure for achalasia, certain lifestyle and dietary changes can help manage the symptoms and improve the quality of life for individuals with this condition. Here are some suggestions:

- Eating habits: Adjusting your eating habits can help alleviate symptoms. It's advisable to eat smaller, more frequent meals throughout the day instead of large meals. Eating slowly, taking smaller bites, and chewing thoroughly can also aid in digestion.
- Food consistency: Choosing softer or more easily digestible foods can make swallowing easier. You may want to avoid foods that are hard, dry, or tough to chew, as they can exacerbate swallowing difficulties.
- Liquid intake: Drinking plenty of fluids, especially while eating, can help food pass through the esophagus more smoothly. Sipping water or other liquids between bites can make swallowing easier.
- Temperature considerations: Some individuals with achalasia find it helpful to consume warm or room temperature foods and beverages, as extreme temperatures may trigger discomfort.
- Body position: Modifying your body position while eating can make swallowing more comfortable. Some people find it beneficial to sit upright and maintain good posture during meals. Experimenting with different positions, such as tilting the head forward or to the side, may also be helpful.
- Diet modifications: While there is no specific diet for achalasia, some individuals find that avoiding certain foods can reduce symptoms. Common trigger foods include spicy foods, citrus fruits, tomatoes, and carbonated beverages. Keeping a food diary can help identify specific foods that worsen symptoms for you.
- Weight management: Maintaining a healthy weight is important for overall well-being. However, achalasia can sometimes lead to unintended weight loss due to difficulties with eating. Consulting with a registered dietitian can help ensure you receive adequate nutrition while managing any weight concerns.
- Stress management: Stress and anxiety can worsen symptoms in some individuals. Exploring stress reduction techniques such as deep breathing exercises, meditation, or engaging in relaxing activities may be beneficial.

Symptoms

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Inability to swallow and regurgitating food or saliva
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1128
Difficulty swallowing
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Heartburn
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1130
Vomiting
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1131
Chest pain
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1132
Coughing

Confirmation Tests

- Esophageal manometry
- X-rays
- Upper endoscopy

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Supplimentary Articles

Historical fix of achalasia using pneumatic dilation

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