Achalasia, (Swallowing Disorder) A Simple Guide To The Condition, Diagnosis, Treatment And Related Conditions

by Kenneth Kee

Overview

Achalasia is a swallowing disorder of motility of the lower esophageal or cardiac sphincter.
The smooth muscle layer of the esophagus has decreased peristalsis and inability of the sphincter to relax produces a functional stricture or functional esophageal stenosis.
The tube that brings food from the mouth to the stomach is the esophagus.
Achalasia makes it harder for the esophagus to move food into the stomach.
Achalasia is a serious condition that affects the esophagus.
The lower esophageal sphincter (LES) is a valve that blocks off the esophagus from the stomach.
If the patient has achalasia, the LES is unable to open up during swallowing, which it is supposed to do.
This results in a backup of food within the esophagus.
This disorder may be inherited, or it may be the effect of an autoimmune disorder, which happens when the body’s immune system wrongly attacks healthy cells in the body.
The degeneration of nerves in the esophagus often adds to the advanced symptoms of the condition.
The most frequent presenting symptom is dysphagia (difficulty in swallowing).
This involves the swallowing of solids more than soft food or liquids.
People with achalasia will often have problem swallowing or a sensation of food being stuck in their esophagus.
This symptom can produce coughing and increases the risk of aspiration, or inhaling or choking on food.
Regurgitation may happen in 80-90% and some patients learn to force it to alleviate pain.
Chest pain, which may become worse after eating, or may be felt as pain in the back, neck, and arms
The barium swallow in achalasia is typical.
The distal esophagus has a narrow segment and the X-ray image looks like a bird's beak.
This is different to the rat's tail appearance of carcinoma of the esophagus.
Manometry is the gold standard test for diagnosis of achalasia and can diagnose up to 90% of patients.
The doctor may make use of esophageal manometry to diagnose achalasia.
The purpose of treatment is to decrease the pressure at the sphincter muscle and permit food and liquids to pass easily into the stomach.
Most achalasia treatments affect the LES.
Several types of treatment can either transiently decrease the symptoms or permanently change the function of the valve.
The first line of treatment is often oral medicines.
1. Nitrates or calcium channel blockers can help loosen the sphincter so food can pass through it more readily.
2. The doctors might also make use of Botox to relax the sphincter.
To treat achalasia more permanently, the doctors can either enlarge the sphincter or change it.
1. Dilation normally requires inserting a balloon into the esophagus and inflating it.
This expands out the sphincter and assists the esophagus to work better.
Occasionally dilation can produces tears in the sphincter.
If this occurs, the patient may require more surgery to repair it.
2. Esophagomyotomy is a form of surgery that can assist the patient if the patient has achalasia.
The doctor will use a large or small incision to reach the sphincter and carefully change it to permit better flow into the stomach.
3. The Heller myotomy is normally considered the best treatment for those who are fit.
Pneumatic dilatation is the favored option for older unfit patients.
If a perforation happens, emergency surgery is required to close the perforation and do a myotomy.
Multiple balloon dilatation with progressive balloon diameter at two months, two years and six years is more effective.
Peroral endoscopic myotomy and endoscopic stent insertion is techniques being explored.
Operative failure may be treated by repeat operation, dilatation or, in extreme circumstances, esophagectomy.
TABLE OF CONTENT
Introduction
Chapter 1 Achalasia
Chapter 2 Causes
Chapter 3 Symptoms
Chapter 4 Diagnosis
Chapter 5 Treatment
Chapter 6 Prognosis
Chapter 7 Dysphagia
Chapter 8 Gastroparesis
Epilogue

Product Details

BN ID:	2940154064849
Publisher:	Kenneth Kee
Publication date:	03/19/2017
Sold by:	Smashwords
Format:	eBook
Sales rank:	860,254
File size:	128 KB

About the Author

Medical doctor since 1972. Started Kee Clinic in 1974 at 15 Holland Dr #03-102, relocated to 36 Holland Dr #01-10 in 2009. Did my M.Sc (Health Management ) in 1991 and Ph.D (Healthcare Administration) in 1993. Dr Kenneth Kee is still working as a family doctor at the age of 65. However he has reduced his consultation hours to 3 hours in the morning and 2 hours in the afternoon. He first started writing free blogs on medical conditions seen in the clinic in 2007 on http://kennethkee.blogspot.com. His purpose in writing these simple guides was for the health education of his patients which is also his dissertation for his Ph.D (Healthcare Administration). He then wrote an autobiolographical account of his journey as a medical student to family doctor on his other blog afamilydoctorstale.blogspot.com. This autobiolographical account “A Family Doctor’s Tale” was combined with his early “A Simple Guide to Medical Conditions” into a new Wordpress Blog “A Family Doctor’s Tale” on http://ken-med.com. From which many free articles from the blog was taken and put together into 550 amazon kindle books and some into Smashwords.com eBooks. He apologized for typos and spelling mistakes in his earlier books. He will endeavor to improve the writing in futures. Some people have complained that the simple guides are too simple. For their information they are made simple in order to educate the patients. The later books go into more details of medical conditions. The first chapter of all my ebooks is always taken from my blog A Simple Guide to Medical Conditions which was started in 2007 as a simple educational help to my patients on my first blog http://kennethkee.blogspot.com. The medical condition was described simply and direct to the point. Because the simple guide as taken from the blog was described as too simple, I have increased the other chapters to include more detailed description of the illness, symptoms, diagnosis and treatment. As a result there are the complaints by some readers of constant repetitions of the same contents but in detail and fairly up to date. He has published 550 eBooks on various subjects on health, 1 autobiography of his medical journey, another on the autobiography of a Cancer survivor, 2 children stories and one how to study for his nephew and grand-daughter. The purpose of these simple guides is to educate patient on health conditions and not meant as textbooks. He does not do any night duty since 2000 ever since Dr Tan had his second stroke. His clinic is now relocated to the Bouna Vista Community Centre. The 2 units of his original clinic are being demolished to make way for a new Shopping Mall. He is now doing some blogging and internet surfing (bulletin boards since the 1980's) starting with the Apple computer and going to PC. All the PC is upgraded by himself from XT to the present Pentium duo core. The present Intel i7 CPU is out of reach at the moment because the CPU is still expensive. He is also into DIY changing his own toilet cistern and other electric appliance. His hunger for knowledge has not abated and he is a lifelong learner. The children have all grown up and there are 2 grandchildren who are even more technically advanced than the grandfather where mobile phones are concerned. This book is taken from some of the many articles in his blog (now with 740 posts) A Family Doctor’s Tale. Dr Kee is the author of: "A Family Doctor's Tale" "Life Lessons Learned From The Study And Practice Of Medicine" "Case Notes From A Family Doctor"