Esophageal achalasia

Introduction to esophageal achalasia Athelixia is a primary general esophageal motor dysfunction disease characterized by: 1 no peristalsis in the esophageal body. 2 The lower esophageal sphincter does not relax or is not completely relaxed when swallowing. 3 At the resting time, the lower end of the esophageal sphincter pressure increased. Although achalasia is a benign disease, it has a great impact on quality of life, health and longevity. Due to difficulty in swallowing, patients can use all methods, including body position, drinking water, repeated swallowing, etc., so that patients are ashamed to eat in front of everyone. May eat alone, causing psychological stress and seriously affecting social activities. basic knowledge The proportion of illness: 0.076% Susceptible people: no specific population Mode of infection: non-infectious Complications: difficulty swallowing Esophageal hiatus hernia

Causes of esophageal achalasia

The disease is characterized by distal esophageal stenosis, prolonged flexion of the body, thickening of the muscular layer, especially the ring muscle, histological examination of ganglion cells, mononuclear cell infiltration of the intestinal myenteric plexus in the esophagus and Fibrosis, the number of ganglion cells in the distal esophagus is reduced, vagus nerve fibers, regardless of myelin rupture, neurofilament rupture, axoplasmic swelling, axonal - Xuwang membrane and axonal membrane separation, vagus nerve dorsal nucleus And the structure has abnormal changes, the ultrastructure of esophageal smooth muscle can be seen off the microfilament, therefore, it can be seen from the brain stem, vagus nerve fibers, intestinal muscle plexus until the muscle nerve fibers are degenerative, the esophagus loses innervation, But how the virus, exotoxin, cancer, parasites and gastrin affect, and where the primary lesions are, etc., the pathogenesis is still unclear.

Prevention of esophageal achalasia

There is no effective preventive measure for this disease, and early diagnosis and early treatment are the key.

Complications of esophageal achalasia Complications dysphagia esophageal hiatus hernia

The complications of this disease are mainly caused by surgery, including:

1 symptoms are not relieved; after sclerosing, there is still dysphagia, or early recurrence, often due to insufficient muscle wall incision, residual ring muscle fiber filaments, or small blood vessels outside the mucosa are not broken, the mucosa naturally bulges incomplete.

2 symptoms recurrence after esophageal muscle incision; after an asymptomatic stage of esophageal myotomy, the symptoms recurred.

3 mucosal perforation; inadvertently cutting the mucosa when the muscle layer is incisive and separated from the esophagus, or electrocoagulation during hemostasis, or perforation may occur after strong postoperative vomiting.

4 esophageal hiatus hernia and hernia; esophageal hiatus hernia is cut in the esophageal muscle layer, the hole is cut open and the hole supporting tissue is destroyed and not noticed, so untreated, the abdominal cavity content is broken from the crack when the abdominal pressure is increased It is squeezed into the chest and retracted into the abdominal cavity when the abdominal pressure is lowered.

is due to the incision of the esophagus muscle layer or anti-reflux mechanism when the diaphragm is not properly repaired, or due to sudden increase in abdominal pressure such as severe cough and vomiting will be sutured and finger exploration.

5 reflux esophagitis: postoperative reflux or reflux esophagitis, such as post-sternal pain or upper abdomen burning, acid reflux or hematemesis, after eating, the body can not bend forward and bow, even because Pain and refuse to eat, esophagoscopy can see local congestion, edema, erosion or superficial ulcer outside the lower end of the esophagus.

Symptoms of esophageal achalasia Common symptoms Anti-stomach sternal pain Weight loss Nervous dysphagia

The incidence rate is low, about 1/100,000, may have a family history, mainly for dysphagia, nausea and chest pain, generally reproduce symptoms for a long time, but the symptoms of children are not obvious, often non-specific and confusing symptoms, will be behind Narrated in children with achalasia.

1. Dysphagia: There are several characteristics:

1 When you start eating, there is no immediate difficulty in swallowing. As the amount of food intake increases, the symptoms become apparent due to obstruction of the esophagus.

2 Regardless of whether it is solid or fluid, sometimes the difficulty of swallowing when entering the food is quite different.

3 The degree of difficulty in swallowing is inversely proportional to the degree of esophageal dilation, that is, the more dilated the esophagus, the lighter the difficulty in swallowing.

4 Esophageal emptying mainly depends on gravity, so patients can take various ways, such as standing or eating, drinking a lot of liquid and swallowing hard, repeatedly swallowing, deep exhalation, and other activities, mainly to increase Pressure in the esophagus forces food into the stomach.

5 fast meals, using cold or overheated food and emotional stimuli and other adverse stimuli can make the difficulty of swallowing worse.

2. Reflux: reflux symptoms are worse than dysphagia. With the development of the disease, the time of reflux is different from that of reflux. About 90% of patients in the early stage of the disease occur in meals and after meals. The content is just the food that has just been eaten, the amount is small. With the continuous expansion of the esophageal body, the capacity of the esophagus gradually expands, and the large one can reach more than 1L. The number of reflux is less than before, and may occur once every 2 to 3 days. The amount of filling increased compared with the previous one, and the food that was eaten overnight or even a few days ago had a stinky stench. About 57% of the patients had reflux during their lying position, and when they woke up, they found a pillow or a sputum with a reflux. Some patients do not care about this carelessness, but should be carefully consulted by experienced doctors in order to gain a deep understanding of the disease, but also ask whether there is any aspiration caused by reflux during sleep, and an unbearable high cough Because of severe cough, I am forced to sit up, especially for the occurrence or frequent occurrence of bronchitis, lung infection, lung abscess, and stagnation of the stagnation. It should be thought that it may be caused by reflux of the esophagus. To height Pay attention to the presence or absence of concurrent cancer, because about 3% of these patients have cancer.

3. Chest pain: There is spontaneous post-sternal pain in the early stage of the disease, which can be radiated to the shoulder arm and the lower jaw for several minutes to several hours. When the esophagus expands to prolonged flexion, the pain disappears. When the pain occurs, enter the drink or sublingual The use of nitric acid can alleviate the cause of pain, which is still unclear.

4. Weight loss and bleeding: Due to difficulty in swallowing, patients often fear to eat, lack of nutrient intake, resulting in varying degrees of weight loss, malnutrition, etc., bleeding is rare, mostly due to esophageal inflammation, but can not be ignored The possibility of cancer.

Examination of esophageal achalasia

1. X-ray inspection :

X-ray examination is very important for the diagnosis of achalasia, and common chest radiography and esophagography have unique performance.

(1) Ordinary X-ray chest.

(2) Esophageal angiography.

2. Gastroscopy.

3. Esophageal manometry.

Diagnosis and diagnosis of esophageal achalasia

Can be diagnosed based on clinical symptoms and laboratory tests.

Differential diagnosis

The disease needs to be differentiated from mediastinal tumor, angina pectoris, esophageal neurosis and the like.

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. The esophagus has only mild dilatation. The differential diagnosis of this disease and esophageal cancer is the most. Importantly, the X-ray features of cancerous esophageal stricture are local mucosal destruction and disorder; the stenosis is moderately dilated, and the disease often causes extreme expansion.

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