overview of the esophagus
The esophagus is a muscular tube that about 25 cm long, it 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.
at the lower part of the esophagus there is a lower sphincter. The function of the lower sphincter is to prevent food from refluxing backwards into the stomach. The sphincter naturally relaxes when eating and contracts when the esophagus is empty of food or liquids.
In normal conditions, the lower esophageal sphincter 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 lot of digestive diseases are associated with the function 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 cardiospasm both refer to the same disease.
Achalasia occurs when the lower esophageal sphincter fails to relax properly while eating, preventing food from reaching the stomach.
Over time, Achalasia results in a clear expansion of the esophagus and the accumulation of food in it, which may cause the contents of the esophagus to go back towards the mouth and a feeling of bad taste.
Achalasia 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.
At the 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 reason behind the occurrence of achalasia is not clearly understood, but some hypotheses explain the reason for the presence of damage to the nerve plexuses responsible for esophageal motility.
symptoms of achalasia
Some patients may not have any symptoms, but the majority of patients with achalasia complain of some symptoms, including:
- difficulty swallowing for both solids and liquids (most common presentation)
- Regurgitation or reflux of undigested food
- Frequent chest pain that is exacerbated by eating
- frequent burping
- night cough
- Malnutrition and being underweight (due to pain that increases while eating)
- pneumonia (caused by inhaling the contents of the digestive tract)
diagnoses of achalasia
Diagnosing this disease can be difficult because it is mixed with many other digestive diseases that cause similar symptoms.
Diagnosis of a patient with symptoms of achalasia is through several methods, including:
This method is considered one of the most important methods in studying diseases of the esophagus. The patient is given a barium preparation, which is often in liquid form, and then x-rays of the esophagus are performed.
Because of achalasia, the esophagus is dilated with a narrowing at the bottom so that the esophagus takes the form of a bird's beak.
The doctor inserts a flexible tube equipped with a camera through the patient’s mouth or nose to reach 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 cancerous growths within it. This technique helps in evaluating the complications of achalasia.
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 acalzia.
The test is performed by inserting a flexible tube containing special sensors through the patient's nose to the stomach.
Achalasia treatment in Turkey
Several treatment options are available, all of them plan to relieve the pressure of the lower esophageal sphincter so that it can relax properly and allow food to pass into the stomach.
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, and then 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 the symptoms of the disease in about 50 to 90% patients. We may need to repeat the balloon dilation procedure if the symptoms of achalasia return. According to studies, one third of patients treated with the balloon dilatation method need re-dilation every five years.
Botulinum Injection (Botox)
The Botox works as a muscle relaxant that helps 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). Repeated injections of Botox make the surgical procedure difficult, so it is recommended to perform a Botox injection in patients who are not candidates for surgery or balloon dilatation.
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 achalasia treatments.
Surgical treatment of achalasia
The surgical procedures that are performed for the management of achalasia are:
The surgeon cut a 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 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 (Nissin operation) in conjunction with the Heller operation.
Oral endoscopic myotomy
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.