achalasia

WHAT IS ACHALAZIA?

Achalasia is a condition characterized by the inability of the muscles at the lower end of the esophagus and the sphincter mechanism (the system that allows the passage of food) between the stomach and the esophagus to relax, resulting in stenosis at the lower end of the esophagus. It is a disease whose exact cause is unknown. This disease, which is most common between the ages of 30-60, manifests itself with difficulty in swallowing, which gradually comes to the fore.

WHAT IS THE CAUSE OF ACHALAZIA? WHAT DISEASES IS IT CONFUSED WITH?

It occurs as a result of the lower valve of the esophagus not being able to relax. In this valve, the stimulation of smooth muscles is impaired and the excitatory nerve cells that provide relaxation are affected. It can also be seen in familial or together with some neurological diseases (Parkinson's). Some diseases involving the esophagus, such as scleroderma and Chagas disease, can also cause relaxation in the esophagus, creating a picture similar to achalasia. Tumors such as esophageal cancer, upper end stomach cancer, and lymphoma can also narrow the lower end of the esophagus and create achalasia-like clinical pictures.

WHAT ARE THE SYMPTOMS OF ACHALAZIA?

• Difficulty in swallowing:It is the most common and obvious complaint, especially swallowing solid foods and liquid foods in the later stages becomes difficult. (paradoxical dysphagia)
• Weight loss, >In the later stages of the disease, weight loss of up to 5-10 kilos may occur
• Difficulty in belching
• Undigested food coming back into the mouth
• Chest pain
• Excessive salivation
• Esophageal ulcer and its complications It is seen in the advanced stages of the disease

HOW IS ACHALAZIA DIAGNOSIS?

• Direct chest radiography
• Barium esophagus radiography: is the first and most used method. The lower part of the esophagus narrows and takes on the appearance of a bird's beak, and the upper part widens, a typical radiological image.
• Computed Tomography (CT):Expansion in the esophagus and pressure on the surrounding organs are observed.
• Endoscopy, biopsy and endo-ultrasound(Endo US) may be added if necessary
• Examination of the esophagus with a manometer:Manometric examination is also important to confirm the diagnosis.

WHAT ARE THE TREATMENTS OF ACHALAZIA?

• Drug therapy, Smooth muscle relaxants such as nitrates or calcium channel blockers are used.
• Botilinum toxin, Clostridium botilinum It is administered by injecting the substance obtained from the bacterium (botulinum toxin) into the lower valve of the esophagus during endoscopy. It acts by blocking long-term reversible nerve conduction in the nerve cells that provide contraction.
• Expanding the esophagus with endoscopic instruments, (dilatation)
• Surgery
• Surgery
strong>, (Myotomy procedure) The muscle in the lower part of the esophagus is partially cut in order to ensure easy emptying of the esophagus. Different surgical methods in which this procedure is performed have been described; The experienced surgeon will apply the intervention that is most suitable for the patient. The surgery can be performed through the chest cavity or through an abdominal approach.