Achalasia

Introduction to achalasia Esophagealachalasia, also known as sputum sputum, is the number of ganglion cells in the esophageal wall plexus, or even disappears, can affect the entire thoracic esophagus, but the most obvious in the middle and lower part of the esophagus, commonly used names in the domestic literature. There are sputum and achalasia. The main features are the lack of peristalsis of the esophagus, the lower esophageal sphincter (LES) high pressure and the relaxation response to swallowing action. The clinical manifestations are difficulty in swallowing, food reflux and posterior sternal discomfort or pain. This disease is a rare disease ( It is estimated that only about 1 in 100,000 people) can occur at any age, but most commonly in the age group of 20 to 39 years old, children are rarely ill, and the incidence of men and women is roughly equal, more common in Europe and North America, the disease The risk of esophageal cancer is potentially untimely. basic knowledge The proportion of illness: 0.012% Susceptible people: no specific population Mode of infection: non-infectious Complications: pneumonia, lung abscess, cardia cancer

Causes of achalasia

Neuropathy (50%):

The etiology of this disease is still unclear. It is generally believed that this disease is a neurogenic disease. The lesion can be seen in the esophageal wall of the vagus nerve and its dorsal nucleus and the esophageal wall. The ganglion cells in the myenteric plexus are reduced or even completely absent, but LES The reduction within the body is lighter than the esophageal body. As a result, animal experiments have shown that freezing or severing the vagus nerve above the thoracic level (both sides) can cause lower esophageal motility and poor LES relaxation, while vagus nerve below the unilateral or lower thoracic level does not affect the function of LES. It can be seen that the innervation of the vagus nerve only ends in the upper part of the esophagus, while the function of the lower end of the esophagus is dominated by the intermuscular nerve plexus of the esophageal wall. The neurotransmitters are purine nucleotides and vasoactive intestinal peptide (VIP). The VIP in the LES of this patient was 8.5±3.6mol/g, which was significantly lower than that of normal people (95.6±28.6mol/g). VIP had the effect of inhibiting the LES tension at rest, and the VIP in LES was significantly reduced. The LES loses its inhibitory effect and the tension increases, causing achalasia.

Virus infection (3%):

Some chronic animal models of esophageal achalasia are produced by bilateral cervical vagotomy or by toxins destroying the ganglion cells of the dorsal nucleus of the vagus nerve or the intermuscular nerve plexus of the esophagus. In addition, the trypanosoma of South America invades the esophageal muscle layer. Excretion of exotoxin, destruction of the nerve plexus, can lead to LES tension and esophageal enlargement (Chageas disease), gastric muscle invasion of LES myometrial plexus can also cause symptoms similar to this disease, some patients with esophageal achalasia have difficulty swallowing Often sudden, and with the vagus nerve and esophageal wall muscle plexus degeneration, it is also believed that the disease may be caused by neurotoxic virus, but has not been confirmed so far, although there have been reports in the literature, in the same family Many people suffer from this disease, and occasionally the twins have the same disease, but whether the disease has a genetic background is not certain.

Other factors (20%):

It is believed that viral infection, toxins, nutrient deficiencies and local inflammation may be the cause of this disease, but no virus particles are found in the vagus nerve and intramural plexus by electron microscopy. The virus infection theory is not supported. Some children have a family history. It suggests that the onset is related to genes. Clinical studies have found that mental concerns can aggravate the symptoms of children, and consider whether the cortical neurological dysfunction caused by mental stimulation leads to central and autonomic dysfunction. In recent years, HLA DQw antigen and the disease have been discovered. Closely related and found in the patient's serum an autoantibody that antagonizes the gastrointestinal nerves, suggesting that the disease has autoimmune factors.

Pathogenesis:

The exact pathogenesis of achalasia is still unclear. The basic defect is neuromuscular abnormality. Pathological findings include different degrees of muscular plexus lesions in the esophageal body and the lower esophageal sphincter. Mononuclear cells in the Auerbach cluster are infiltrated. The whole ganglion cells were replaced by fibrous tissue. The vagus nerve had Wallerian degeneration. The nerve cells in the dorsal motor nucleus were lost. The esophageal smooth muscle was normal under light microscope, but under the electron microscope, the surface of the microfilament was detached and the cells were atrophied. It is unclear whether the change is primary or secondary. In summary, the results of histology, ultrastructural and pharmacological studies indicate that the esophagus of achalasia has been denervated, and the lesion is located in the brainstem, vagus nerve fibers, Auerbach plexus and muscle. Internal nerve fibers, but can not clarify where the primary lesions are, may have diffuse neurodegenerative changes or neurotoxic substances affecting all nervous systems from the brain to the muscle fibers.

The pathophysiological mechanisms of achalasia are as follows:

1. Neurogenic lesions: patients with esophageal myenteric plexus (Auerbach plexus) ganglion cells decreased, absent, degenerative changes, neurofibrosis, no pathological changes suggesting exogenous neuropathy, patients with esophageal body and The muscle cord in the LES region does not respond to stimulation at the ganglion level, while the direct action of acetylcholine can cause a contractile response. It is also reported that the patient's esophagus is highly reactive to cholinergic agents, ie, strong segmental contractions occur, according to Cannon The law, that is, the tissue that loses the autonomic nerve is more sensitive to the response of the neurotransmitter, indicating that the lesion is mainly in the nerve.

2. Inhibitory neuronal involvement: LES region nerve excitability (cholinergic) and inhibitory (non-cholinergic non-adrenergic NANC), vasoactive intestinal peptide (VIP) and nitric oxide (NO) It is a NANC-inhibiting neurotransmitter that mediates smooth muscle relaxation. The nerve fibers in the lower esophagus are significantly reduced in patients with achalasia. The abnormal contraction of cholecystokinin (CCK) in patients with LES also suggests inhibitory nerve damage. The patient's LES responds differently to drugs such as opioid peptides, and also suggests abnormalities in nerve or myocyte receptors.

3. Abnormal vagus nerve function: The patient with this disease has obvious gastric acid secretion disorder, similar to the symptoms after vagus nerve resection, suggesting that there is vagus nerve dysfunction.

In summary, due to vagus central and esophageal wall plexus lesions, inhibitory neurotransmitter deficiency, esophageal denervation atrophy and vagus nerve dysfunction and other factors lead to elevated LES resting pressure; LES relaxation or complete relaxation at the time of swallowing The esophageal body is inconsistent with movement and movement, and has no promoting effect on food, so that the food stays in the esophagus. When the internal pressure of the esophagus exceeds the LES pressure, a small amount of food can slowly pass due to gravity, and the long-term contents of the esophagus remain. Lead to esophageal dilation, prolongation and flexion, esophageal inflammation, ulceration or canceration. In recent years, some studies have found that some patients have crease contraction after esophagectomy after treatment of LES obstruction, so it is considered that the non-peristaltic contraction of the esophageal body is not primary, and It is related to LES obstruction.

The achalasia affects the entire thoracic esophagus, and is not limited to the cardia. At the beginning, the esophagus is normal in anatomy, later hypertrophy, dilatation, and loss of normal peristalsis. After the sphincter, the hypertrophy, dilatation, and loss of normal peristalsis, the sphincter can not Relaxation, abnormality is mainly limited to the inner layer of the circumflex muscle, while the outer longitudinal muscle function is normal, according to the extent of esophageal dilation, light, medium, and heavy 3 degrees,

1 Mild: no obvious dilatation or expansion of the esophageal cavity is limited to the lower part of the esophagus. Generally, the diameter of the lumen is <4cm, no or only a small amount of food and fluid retention, and the esophagus can be seen to promote contraction.

2 Moderate: The esophageal lumen is dilated. The diameter of the lumen is <6cm. There is more food and fluid retention, and the esophagus rarely promotes contraction.

3 Severe: The esophageal lumen is extremely dilated, the diameter of the cavity is >6cm, there is a large amount of food and liquid retention, and the esophagus does not see push contraction.

Achalasia prevention

Eat small meals, eat and chew, avoid overheating and irritating diet, psychological treatment and external agents for people with nervous nervousness, some patients use Valsalva action to promote food from the esophagus into the stomach, relieve post-sternal discomfort, Sublingual nitroglycerin can relieve esophageal spasm, such as empty esophageal emptying.

Complications of achalasia Complications, pneumonia, lung abscess, cardiac cancer

1. Respiratory complications: occur in about 10% of patients, more obvious in children, aspiration pneumonia due to reflux vomiting, bronchiectasis, lung abscess and pulmonary fibrosis are the most common, inhalation of atypical mycobacteria combined with esophagus The oil retained in the sputum can induce chronic lung changes, similar to clinical and X-ray tuberculosis. Anti-acid bacteria can be found in sputum, which may be atypical mycobacteria. Don't mistake Mt. tuberculosis, there are 3 mechanisms that can cause respiratory complications. :1 The contents of food are inhaled into the trachea or bronchus. When the esophageal reflux is invaded into the airway, it can cause bronchial and pulmonary infections, especially when it is asleep. About 1/3 of patients may have paroxysmal cough or repeated at night. Respiratory infections, most often occur in dilated esophagus, especially when lying down at night, repeated small amounts of aspiration, accompanied by cough, wheezing, shortness of breath and other symptoms; 2 significantly enlarged and filled esophageal tracheal compression, so that breathing and Poor drainage; 3 concurrent cancer caused by esophagus and trachea, or left bronchial fistula, can cause serious respiratory symptoms, the first most common, treatment method There after the lifting of esophageal obstruction, pulmonary complications in order to make better, irreversible lung disease sometimes surgical treatment simultaneously with the esophagus.

2. Cancer: It is reported that 2% to 7% of patients can be combined with esophageal cancer, especially in the course of more than 10 years, the esophageal dilatation is obvious, severe retention, mainly caused by chronic inflammation of esophagitis caused by food retention, esophageal muscle layer Incision or dilatation does not prevent the occurrence of cancer. There are reports of cancer that can occur after many years of successful operation. Therefore, it is necessary to carefully observe the presence or absence of esophageal cancer. In case of suspicious circumstances, biopsy examination is performed. Huang Guojun And Zhang Wei et al reported that the incidence of achalasia with esophageal cancer was similar to that of esophageal cancer, mainly male, but the age of onset of achalasia was lighter than that of esophageal cancer patients. The average age of patients with achalasia was 48 to 51 years old, no achalasia age 62 to 67 years old, tumors occur in the middle of the esophagus, followed by the lower esophagus and upper section.

Diagnosis is often delayed, because the patient's digestive tract symptoms are often mistaken for achalasia. When the cancer grows to a larger volume, the esophagus is blocked. The symptoms are weight loss, and the difficulty of swallowing changes from intermittent to progressive. When vomiting occurred in blood-stained substances or anemia, it was found that patients with esophageal cancer were diagnosed with endoscopic biopsy and cytology.

3. Esophagitis: due to ecchymosis in the esophageal food retention, endoscopic examination can be seen with esophagitis and its mucosal ulcers, ulcers can occur bleeding, a few spontaneous perforation, esophageal tracheal fistula, physical weakness or accepted Antibiotic treatment or neutropenia can be combined with Candida infection, endoscopic leukoplakia on the inflammatory mucosa, specimen smear and biopsy can be diagnosed, treatment should first expand and relieve esophageal retention, the disease can not tolerate strong expansion is available Attract drainage to keep the esophagus empty and apply antibiotics.

4. achalasia can be complicated by esophageal or cardiac cancer, the incidence rate is 15%, the reason may be long-term stimulation of the esophageal mucosa, ulceration, mucosal epithelial hyperplasia.

5. Other complications: due to the dilatation of the esophagus of achalasia, the intraluminal tension is increased, and the complications of the supracondylar diverticulum can be treated simultaneously with the treatment of achalasia. A few patients develop rheumatoid arthritis. Joint complications, symptoms can be alleviated after treatment of achalasia.

Symptoms of achalasia, common symptoms, shortness of breath, dry cough, difficulty in eating

(1) difficulty in swallowing: painless difficulty in swallowing is the most common symptom of the disease, accounting for 80% to 95%. The onset is slower, but it can be more urgent. It can be mild at first, only in There is a feeling of fullness after a meal. The difficulty of swallowing is often intermittent. It is often caused by mood swings, anger, anxiety, convulsions or eating irritating foods such as cold and spicy. Sometimes it is difficult to swallow when the disease is early. Light and heavy, and later to continuous, a small number of patients swallowed liquid more difficult than solid food, some people with this sign and other esophageal stricture caused by the difficulty of swallowing, but most patients swallowed solids ratio Liquids are more difficult, or it is equally difficult to swallow solid and liquid foods. Patients have difficulty eating because of mental disorders and are only willing to eat alone.

(2) Pain: about 40% to 90%, different in nature, can be stuffy, burning, acupuncture pain, cut pain or cone pain, pain in the back of the sternum and the upper abdomen; also in the chest The back, right chest, right sternal border and left rib, lasting for a few minutes to a few hours, often occur in the early stages of the disease, especially in patients with severe achalasia, not necessarily related to eating, pain attacks sometimes resemble angina, and even Sublingual nitroglycerin tablets can be relieved, pressure test revealed high amplitude contraction, may be related to esophageal spasm, some pain may occur due to eating too fast or food stuck in the lower part of the esophageal sphincter, with the pharynx The difficulty gradually worsens, and the esophage further expands above the obstruction, and the pain can be gradually reduced.

(3) Food reflux: the incidence rate can reach 90%. With the difficulty of swallowing, the esophagus is further expanded, and a considerable amount of contents can be retained in the esophagus for several hours or several days, and the position changes. When it comes back, the contents from the esophagus are not in the stomach cavity, so there is no characteristic of vomit in the stomach, but it can be mixed with a lot of mucus and saliva. In the case of concurrent esophagitis and esophageal ulcer, reflux It can contain blood, which is later than the difficulty of swallowing. It often occurs during meals, after meals or in lying position. In the early stage of the disease, a small amount of newly entered food is vomited during meals or after each meal. This can relieve the patient's esophagus. Blocking sensation, as the disease progresses, the esophageal capacity also increases, the number of reflux vomiting is quickly reduced, and a large amount of food that has not been digested and smelly a few days ago is reversed. When the esophagus is enlarged, it can accommodate a large amount of food and liquid. When the patient is supine, there is reflux vomiting, especially during nighttime reflux vomiting, paroxysmal cough and bronchial aspiration, respiratory complications such as pneumonia, lung abscess and bronchiectasis, etc. Reflux occurs when the contents have bloody thing, physicians should be alert to the possibility of concurrent cancer.

(4) Weight loss: weight loss is related to the difficulty of swallowing, which affects the intake of food. For patients with difficulty in swallowing, patients often take food, slow food, eat food or eat more soup after food, or food. Straight chest and back, use deep breathing or suffocating to assist in swallowing action, so that food can enter the stomach to ensure nutrient intake. Those who have a long course of disease can still have weight loss, malnutrition and vitamin deficiency, and those with cachexia. rare.

(5) Bleeding and anemia: Patients often have anemia, and occasionally bleeding caused by esophagitis.

(6) Other symptoms: Due to the increase of the lower sphincter tension of the esophagus, the patient rarely suffers from hiccup, which is an important feature of the disease. In the later cases, the extremely dilated esophagus can compress the internal organs of the thorax and produce dry cough, shortness of breath, cyanosis and sound. Deaf and so on.

Examination of achalasia

(1) X-ray examination

1. Barium meal examination: barium meal is often difficult to pass through the cardia and remains in the lower end of the esophagus, and is shown as 1 to 3 cm long, symmetrical, funnel-shaped narrowing of the mucosal pattern party, the upper esophagus exhibits varying degrees of expansion, length and bending , no peristaltic wave, X-ray angiography of esophageal barium meal, see sputum retention in the cardia, the lower part of the esophagus has a smooth edge of the beak-like stenosis, the sputum into the fine flow slowly into the stomach, the middle and lower esophageal cavity is enlarged, the degree is serious The esophageal lumen is highly thickened, prolonging the distortion into an "S" shape, such as the sigmoid colon, and the normal peristalsis of the esophageal wall is weakened or disappeared. Sometimes there is a weak contraction of the rule, which can be distinguished from scar stenosis and esophageal cancer, such as hot drinks. Sublingual nitroglycerin tablets or inhalation of isoamyl nitrite, every esophageal stenosis is relaxed; if cold drink, the cardia is more difficult to relax, and the residual food residue can be filled and filled during barium meal, so it should be For esophageal drainage and lavage.

Esophageal barium meal imaging is an important diagnostic test in cases of achalasia. The morphological and functional characteristics of the esophageal body and distal sphincter should be noted. The catheter should be intubated or rinsed before radiography, X-ray film or Video can provide dynamic observation of esophageal peristalsis activity compared with fluoroscopy. The patient should take the supine position and standing position during the examination to observe the function of esophageal movement. If the esophagus has obvious expansion or a large amount of food residue, the food should be confused with the tumor on the X-ray film. The main feature of X-ray of achalasia is that the peristalsis of the esophageal body disappears. The distal sphincter loses the relaxation reaction when swallowing, and the sputum stays in the gastroesophageal junction. The wall of the tube is smooth, and the sudden narrowing of the lumen is a beak-like change.

2. Chest flat: In the early stage of the disease, the chest radiograph can be free of abnormalities. As the esophagus expands, the right upper edge of the mediastinum can be seen in the posterior anterior chest radiograph. When the esophagus is highly expanded, the mediastinum is widened. Exceeding the right edge of the heart, sometimes it can be misdiagnosed as a mediastinal tumor. When a large amount of food and gas are trapped in the esophagus, the liquid is visible in the esophagus. In most cases, the gastric vesicle disappears. In the case of pneumonia or lung abscess, the lung field changes. Cases may not be abnormal during X-ray examination.

(two) esophageal force mechanics examination

1. The pressure in the high pressure area of the lower end of the esophageal pressure measuring tube is more than twice that of normal people. The lower esophageal and sphincter pressures do not decrease when swallowing, and the upper and middle esophageal pressures are higher than normal. This method can reflect the esophagus from the pathophysiological point of view. The motion pathology can confirm or confirm the disease, and can be used as a quantitative indicator of drug efficacy, dilatation and evaluation of esophageal function after esophagectomy.

2. Esophageal emptying examination including nuclear vegetarian tube passage time, esophageal tincture emptying index measurement and drinking water test, etc., are helpful to judge the esophageal emptying function, and also used to evaluate the therapeutic effect on esophageal function.

3. Methacholine chloride was injected subcutaneously with methacholine chloride 5-10 mg. In some cases, the esophageal contraction was enhanced, and the upper and middle esophageal pressures were significantly increased, which may cause severe pain after the sternum. The patient has a strong contraction of the esophagus, and the pressure in the esophagus increases sharply, resulting in severe pain and vomiting under the sternum. The X-ray signs are also more obvious, but the test is less specific.

(three) endoscopy and cytology

Esophagoscopy can confirm the diagnosis, exclude esophageal scar stenosis and esophageal tumor, the lower end of the esophagus and the cardia are not closed, the liquid or food in the esophagus is retained, the esophageal lumen is enlarged, and the esophageal dilatation is like the stomach cavity. The esophagus is twisted in an S-shape. The esophageal wall is sometimes seen with a circular contraction ring. It often does not see push-primary or secondary contraction. Due to dilatation of the esophagus, distortion, esophageal lengthening, incisor to gingival tooth line Often >40cm, the lower end of the esophagus and the cardia are continuously closed, and the gas is not open. The endoscope passes through the resistance. Generally, it can enter the stomach cavity with a little force. When you turn over the observation, you can see the "tight hug", that is, the endoscope The body of the lens, the light push-pull endoscope can be seen that the mucosa of the cardia moves up and down, and the mucosa of the esophagus is accompanied by a change of retention inflammation. The following paragraphs are obvious, and the mucosal congestion and color redness seen with reflux inflammation are different, and the esophageal dilation is more serious. The mucosal inflammation is also more obvious. The mucosa in the lower esophagus is obviously white, thick and rough, and there may be signs of "cracking". In severe cases, nodular changes may occur, and there may be erosions and shallow ulcers. When nodules appear, Rotten, ulcer, should be alert to the concurrent esophageal cancer.

Abnormal blood can be found in routine examination of peripheral blood, infection with blood in the case of aspiration pneumonia, increased white blood cell count and increased neutrophils.

Diagnostic diagnosis of achalasia

diagnosis

All patients with difficulty in swallowing and returning to eating, and no history of swallowing agents or other injuries should consider the possibility of achalasia. Physical examination does not help the diagnosis. The only thing worth mentioning is the time of swallowing, ie the liquid The time required for the mouth to enter the stomach is determined. The patient takes the upright position during the examination. The examiner places the stethoscope under the xiphoid of the upper abdomen of the patient, and the patient drinks water. The appearance of the water sound marks the water entering the stomach, and the normal swallowing. The time is 8 to 10 s. The achalasia is greatly prolonged or completely inaudible. The laboratory examination does not help the diagnosis. The diagnosis depends on X-ray, endoscopy and pressure measurement.

Differential diagnosis

First, mediastinal tumor, angina pectoris, esophageal neurosis and esophageal cancer, cardiac cancer, etc.:

Mediastinal tumors have no difficulty in differential diagnosis. Most of the angina pectoris is induced by exertion. This disease is induced by swallowing and has difficulty in swallowing. This can be identified. Most of the esophageal neurosis (such as sputum) is expressed as There is a foreign body obstruction in the pharyngeal to esophageal area, but there is no symptoms of infarction, benign esophageal stricture and reflex esophageal fistula caused by stomach and gallbladder lesions, only mild dilatation of esophagus, this disease and esophageal cancer, cardiac cancer Differential diagnosis is the most important. The X-ray features of cancerous esophageal stricture are local mucosal destruction and disorder; the stenosis is moderately dilated, and the disease is often extremely dilated. The stenosis caused by esophageal and cardiac cancer is due to the invasion of the tumor tissue. As a result, the mucosa is destroyed, ulcers, lumps, etc. can be formed. The lesions are mainly on one side of the wall, the stenosis is poorly dilated, the endoscopic resistance is large, and the stenosis is often difficult to pass. perforation.

The X-ray diagnosis of achalasia is generally not difficult. The typical X-ray findings are a bird's beak-like stenosis at the lower end of the esophagus, but the cardia cancer, especially the narrowing type of cancer, can also make the lower end of the esophagus a bird-like stenosis. Through difficulty, it is difficult to distinguish from achalasia. It is worth noting that achalasia can be complicated by esophageal or cardiac cancer, the incidence rate is 315%. The reason may be that the esophageal mucosa is stimulated by the retentate for a long time, ulceration, mucosal epithelium Hyperplasia and so on, so for advanced age, short course of disease, atypical symptoms, the diagnosis of achalasia should be cautious, for patients with achalasia who have been diagnosed for many years should also be alert to the possibility of cancer.

Second, primary and secondary achalasia

There is a primary and secondary achalasia, the latter also known as pseudo achalasia (p seudoachalasia), which refers to malignant tumors such as gastric cancer, esophageal cancer, lung cancer, liver cancer, river pancreatic cancer, lymphoma, etc. Esophageal motility abnormalities similar to primary achalasia caused by Chagas disease, amyloidosis, sarcoidosis, neurofibromatosis, eosinophilic gastroenteritis, chronic idiopathic pseudo-intestinal obstruction Patients with pseudo achalasia have symptoms of dysphagia. X-ray examination has dilatation of the esophageal body. The distal sphincter cannot relax. There is no peristaltic wave in the pressure measurement and X-ray examination. This occurs in the submucosal layer of the esophageal junction. Intestinal muscles have invasive lesions, the most common cause is gastric cancer infiltration, other rare diseases such as lymphoma and amyloidosis, liver cancer can also find similar signs, without pre-expansion in endoscopy, this paragraph can not Passing the device, because the infiltrating lesion is stiff, in most cases the biopsy can be diagnosed, sometimes it is necessary to probe to confirm the diagnosis.

Third, no motility abnormalities

Scleroderma can cause a non-peristaltic motion in the distal part of the esophagus, and it is difficult to diagnose. Because the esophageal involvement often precedes the skin, esophageal manometry shows that the proximal end of the esophagus is often unaffected, while the esophageal body has very few peristaltic waves, and the distal sphincter is often Ineffective, but normal relaxation, no motility dysfunction can also be seen in the accompanying peripheral neurological diseases, such as diabetes and multiple sclerosis patients.

Fourth, dysphagia after vagus nerve cutting

Dysphagia can occur after transection of the vagus nerve through the thoracic or abdominal route. Temporary dysphagia can occur in about 75% of patients after high-selective vagus nerve ablation. In most cases, the symptoms can gradually disappear after 6 weeks, X-ray and measurement. In the pressure test, it can be seen that the distal esophageal sphincter can not be relaxed and accidentally free of peristalsis, but rarely need expansion and surgical treatment, according to the medical history can be identified.

Five, elderly esophagus

Esophageal motor dysfunction in the elderly is due to the degenerative changes of the organs in the esophagus. Most elderly people find that esophageal dysfunction is poor in the pressure test, both primary and secondary peristalsis are obstacles, after swallowing or Spontaneously, there is often no peristaltic contraction, and the number of relaxations of the lower esophageal sphincter is reduced or absent, but the resting pressure in the esophagus does not increase.

Six, Chagas disease

There may be a giant esophagus, a parasitic disease that is prevalent in South America, and affects the whole body organ at the same time. Its clinical manifestations are indistinguishable from achalasia, and the intestinal muscles are degenerated due to secondary parasitic infections. In physiology, pharmacology And the treatment response is similar to primary achalasia. In addition to esophageal lesions, Chagas disease has other visceral changes. Before diagnosis, it must be determined that the patient has lived in South America or South Africa. Fluorescence and complement fixation tests can be used to determine the cone. Past infection history of worm disease.

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