مرض-تعذر-الارتخاء-المريئي-(الاكاليزيا)
}March 13, 2022
jDr.. Muhannad Al-Khatib

All you need to know about achalasia

}March 13, 2022
jDr.. Muhannad Al-Khatib

All you need to know about achalasia

Table of Contents

    Achalasia is one of the rare digestive diseases that affect the esophagus and impede the delivery of food to the stomach. It causes many symptoms, and it is treated in Turkey in several ways.

    A quick overview of the esophagus

    It is a muscular tube about 25 cm long that forms a passage for food and liquids to pass from the pharynx to the stomach.
    When food is eaten, the esophagus works to push the food towards the stomach through peristaltic muscle contractions aimed at moving the food and accelerating its descent into the stomach.
    Anatomically, the lower part of the esophagus has a lower sphincter. The function of the lower sphincter is to prevent food from being refluxed backwards from the stomach. The sphincter naturally relaxes when eating and contracts when the esophagus is empty of food or liquid.
    The lower esophageal sphincter in normal conditions maintains a specific pressure, this pressure keeps the sphincter contracted in normal conditions and prevents its relaxation and regurgitation of the components of the stomach.
    A number of digestive diseases are associated with the condition of the lower esophageal sphincter gastroesophageal reflux disease One of the common diseases associated with a disorder in the work of the lower esophageal sphincter.

    What is achalasia?

    Achalasia or achalasia or cardiospasm are all terms that refer to the same disease. Achalasia is one of the diseases that affect the motility of the esophagus and impede the process of moving food to the stomach.
    Achalasia occurs when the lower esophageal sphincter fails to relax properly while eating, preventing food from reaching the stomach.
    Over time, esophageal insufficiency results in a clear dilatation of the esophagus and food accumulation in it, which may cause the contents of the esophagus to return towards the mouth and a feeling of bad taste.
    Echalasia is often associated with many digestive symptoms that affect the patient's life. Some patients live with these symptoms and are not diagnosed with the condition until late.
    In advanced stages of the disease, paralysis of esophageal motility occurs, when this occurs, the normal function of the esophagus cannot be restored again.
    The main cause of this disease is not clearly understood, but some hypotheses explain the reason for the presence of damage to the nerve plexuses responsible for esophageal motility.
    In the event of delay in treatment, this sometimes leads to an increased risk of infection esophageal cancer.
    Comparison between normal and achalasia

    Comparison between normal and achalasia

    Achalasia symptoms

    • Common difficulty swallowing solids and liquids (most common presentation)
    • Regurgitation or reflux of undigested food
    • Frequent chest pain that is exacerbated by eating
    • frequent burping
    • Feeling heartburn
    • night cough
    • Malnutrition and being underweight (due to pain that increases while eating)
    • Aspiration pneumonia (caused by inhaling the contents of the digestive tract)

    How is achalasia diagnosed?

    Diagnosing this disease can be difficult because it is mixed with many other digestive diseases that cause similar symptoms.
    A patient with achalasia symptoms is diagnosed through several methods:

    Barium swallow

    This method is one of the important methods in the study of esophageal diseases. The patient is given a barium contrast preparation, which is often in liquid form, and then X-ray imaging of the esophagus is done. In the event of achalasia, the esophagus is dilated with a narrowing at the bottom so that it takes The esophagus is shaped like a bird's beak.

     Achalasia in a barium bite examination

    Achalasia in a barium bite examination

    upper endoscopy

    The doctor inserts a flexible tube equipped with a camera through the patient’s mouth or nose into the esophagus, and through it he can also reach the stomach. Through endoscopy, the doctor can see the esophagus and assess the occurrence of infections or precancerous growths Within it, this technique helps in evaluating the occurrence of complications of achalasia.

    upper gastrointestinal endoscopy

    upper gastrointestinal endoscopy

    Esophageal manometry

    It is considered the gold standard in diagnosing achalasia. This examination measures the time and force of esophageal contractions, in addition to measuring the pressure of the lower esophageal sphincter and determining its ability to relax properly. If the lower esophageal sphincter fails to relax after eating, this indicates the infection of achalasia.
    The test is performed by inserting a flexible tube containing special pressure sensors through the patient's nose to the stomach.

    Treatment methods for achalasia in Turkey

    Several treatment options are available, primarily to relieve the pressure of the lower esophageal sphincter so that it can relax properly and allow food to pass into the stomach.

      balloon expansion

    One of the easy-to-apply treatment methods that can be performed in the outpatient clinic, a balloon is inserted through the endoscope into the center of the lower esophageal sphincter, the balloon is inflated with air, which increases the widening of the esophageal sphincter opening and facilitates the passage of food through it.

    This procedure relieves symptoms of the disease in about 50 to 90% patients, we may need to repeat the balloon dilation procedure if symptoms return, according to Studies One third of patients treated with balloon dilation need re-expansion every five years.

    Dilatation with balloon used in the treatment of achalasia

    Dilatation with balloon used in the treatment of achalasia

    botulinum injection (Botox) in Turkey

    Botox acts as a muscle relaxant to help relax the lower esophageal sphincter. Botox is injected directly into the lower esophageal sphincter through an endoscopically guided needle.
    The patient may need to re-inject Botox a large number of times (once every six months). The repeated injections of Botox make the surgery difficult to perform, so it is recommended to perform a Botox injection in patients who are not candidates for surgery or balloon dilatation.

    drug therapy

     The doctor prescribes some muscle relaxants such as nitroglycerin or calcium channel blockers such as nifedipine. The effect of these drugs is weak and their side effects are numerous. Therefore, drug therapy is often the last treatment option for patients who are not candidates for other alkalizia treatments.

    Achalasia Surgical Treatment in Turkey

    The surgical procedures that are performed to manage achalasia are:
    Heller process
    The surgeon biopsy part of the lower esophageal sphincter muscle through the endoscope, which relieves sphincter pressure and allows food to pass more easily into the stomach.
    One of the complications associated with the Heller operation is the occurrence of disease gastroesophageal reflux disease The lower esophageal sphincter relaxes excessively, allowing food to flow backwards.
    To avoid gastroesophageal reflux disease, the surgeon performs a laparoscopic fold of the stomach fundus around the lower esophageal sphincter (Nissen operation) in conjunction with the Heller operation.
    Oral endoscopic muscle biopsy
    In this method, the surgeon inserts the endoscope through the mouth, and then an initial incision is made in the layers of the esophageal wall in order to reach the muscle layer.
    The layers of the esophageal wall are then sutured where the incision was made.

    Why should I choose treatment in Turkey?

    Recently, Turkey has become one of the leading countries in the field of medical tourism in the world.
    The reason for this is due to the presence of advanced medical centers that provide appropriate treatment by the most skilled doctors and the latest medical devices at a low cost.
    and stay Bimaristan Center Medical is your first choice For treatment in Turkey.
    We guide you to the best expert specialists in all departments.
    We facilitate the language of communication between you and everyone through specialized Arab doctors who will help you communicate with your doctor.
    We help you secure the right treatment and high-end service in the most modern hospitals and medical centers in Turkey.
    We provide our services extensively and precisely.
    We accompany you step by step towards recovery.
    Free consultations around the clock.
    do not hesitate Contact usBimaristan, your family center in Turkey.
     

    Frequently asked questions about achalasia

    What is achalasia of the esophagus or achalasia?
    It is a rare disorder that affects the digestive system and causes a defect in the process of food transfer to the stomach. The pathogenic mechanism is the failure of the lower esophageal sphincter muscle to relax when eating, which prevents the passage of food into the stomach. The esophagus loses its ability to peristalsis with the passage of time and becomes paralyzed, which affects the swallowing process. The most common symptom seen in people with achalasia is dysphagia for food and drink.
     
    What are the symptoms of achalasia (aachalasia)?
    • Dysphagia of food and drink (a very common symptom in patients with achalasia)
    • Reflux or reflux of esophageal contents (undigested food)
    • smelly breath
    • Feeling of heartburn (also called heartburn)
    • Chest pain that usually increases when eating
    • Weight loss 
    What are the complications of achalasia esophageal disease?
    Food ingestion disorders in people with alkalizia occur because the lower esophageal sphincter cannot relax properly. Over time, swallowing disorders may cause esophagitis and loss of the ability to peristaltic movement of the esophagus. In addition, a serious complication of acalzia is aspiration pneumonia following resorption of the contents of the digestive system. .
     
    How is achalasia of the esophagus treated?

    There are many types of treatment methods available to manage this disease, one of the methods used to treat alkalisia is balloon expansion, which is usually the first treatment option that is used when the disease is diagnosed, and it is also possible to perform surgical intervention and perform a process aimed at treating this disease and relieving its symptoms called Heller process Botox can also be injected down the esophagus into the loop of the lower esophageal sphincter, a type of disease management method.

    What are the causes of achalasia?
    The causes of the disease are still not clearly understood, some believe that the cause is due to damage to the nerves of the esophageal plexus responsible for controlling the motility of the esophagus, while others believe that the cause of the disorders is due to an immune factor so that special antibodies were found in the blood of some patients.
     

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