Difference between revisions of "Achalasia"
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*[[Chagas disease]] - classically with dilation of the esophagus.<ref name=pmid23317615>{{Cite journal | last1 = Pantanali | first1 = CA. | last2 = Herbella | first2 = FA. | last3 = Henry | first3 = MA. | last4 = Mattos Farah | first4 = JF. | last5 = Patti | first5 = MG. | title = Laparoscopic Heller myotomy and fundoplication in patients with Chagas' disease achalasia and massively dilated esophagus. | journal = Am Surg | volume = 79 | issue = 1 | pages = 72-5 | month = Jan | year = 2013 | doi = | PMID = 23317615 }}</ref> | *[[Chagas disease]] - classically with dilation of the esophagus.<ref name=pmid23317615>{{Cite journal | last1 = Pantanali | first1 = CA. | last2 = Herbella | first2 = FA. | last3 = Henry | first3 = MA. | last4 = Mattos Farah | first4 = JF. | last5 = Patti | first5 = MG. | title = Laparoscopic Heller myotomy and fundoplication in patients with Chagas' disease achalasia and massively dilated esophagus. | journal = Am Surg | volume = 79 | issue = 1 | pages = 72-5 | month = Jan | year = 2013 | doi = | PMID = 23317615 }}</ref> | ||
Treatment:<ref name=pmid22982946>{{Cite journal | last1 = Swanstrom | first1 = LL. | last2 = Kurian | first2 = A. | last3 = Dunst | first3 = CM. | last4 = Sharata | first4 = A. | last5 = Bhayani | first5 = N. | last6 = Rieder | first6 = E. | title = Long-term outcomes of an endoscopic myotomy for achalasia: the POEM procedure. | journal = Ann Surg | volume = 256 | issue = 4 | pages = 659-67 | month = Oct | year = 2012 | doi = 10.1097/SLA.0b013e31826b5212 | PMID = 22982946 }}</ref> | |||
*Endoscopic dilation. | |||
*Per-oral endoscopic myotomy (POEM). | |||
*Laparoscopic myotomy. | |||
==Microscopic== | ==Microscopic== | ||
Revision as of 16:05, 11 February 2017
Achalasia is a benign pathology of the esophagus.
General
- Uncommon.
- Risk factor for squamous cell carcinoma (in men and women) and adenocarcinoma (in men).[1]
- Due to loss of ganglion cells.[2]
Clinical:
- Dysphagia (difficulty swallowing) liquids and solids.[2]
DDx:
- Chagas disease - classically with dilation of the esophagus.[3]
Treatment:[4]
- Endoscopic dilation.
- Per-oral endoscopic myotomy (POEM).
- Laparoscopic myotomy.
Microscopic
Features:[5]
- Mucosa typically normal - even in long-standing achalasia.
Note:[5]
- Achalasia seen in the context of a resection usually has inflammation.
- Post-Heller myotomy often has inflammation.
Sign out
ESOPHAGUS, BIOPSY: - SQUAMOUS EPITHELIUM WITH A MILD DEEP LYMPHOCYTIC INFILTRATE, EDEMA, AND REACTIVE CHANGES, NO EOSINOPHILS APPARENT. - SCANT COLUMNAR EPITHELIUM WITH MINIMAL STROMA, NO APPARENT SIGNIFICANT PATHOLOGY. - NEGATIVE FOR INTESTINAL METAPLASIA. - NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.
Alternate
GASTROESOPHAGEAL JUNCTION, BIOPSY: - COLUMNAR EPITHELIUM WITH MODERATE CHRONIC INFLAMMATION. - REACTIVE SQUAMOUS EPITHELIUM. - NEGATIVE FOR INTESTINAL METAPLASIA. - NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.
See also
References
- ↑ Zendehdel, K.; Nyrén, O.; Edberg, A.; Ye, W. (Jan 2011). "Risk of esophageal adenocarcinoma in achalasia patients, a retrospective cohort study in Sweden.". Am J Gastroenterol 106 (1): 57-61. doi:10.1038/ajg.2010.449. PMID 21212754.
- ↑ 2.0 2.1 Blatnik, JA.; Ponsky, JL. (Jan 2014). "Advances in the Treatment of Achalasia.". Curr Treat Options Gastroenterol. doi:10.1007/s11938-013-0007-2. PMID 24395614.
- ↑ Pantanali, CA.; Herbella, FA.; Henry, MA.; Mattos Farah, JF.; Patti, MG. (Jan 2013). "Laparoscopic Heller myotomy and fundoplication in patients with Chagas' disease achalasia and massively dilated esophagus.". Am Surg 79 (1): 72-5. PMID 23317615.
- ↑ Swanstrom, LL.; Kurian, A.; Dunst, CM.; Sharata, A.; Bhayani, N.; Rieder, E. (Oct 2012). "Long-term outcomes of an endoscopic myotomy for achalasia: the POEM procedure.". Ann Surg 256 (4): 659-67. doi:10.1097/SLA.0b013e31826b5212. PMID 22982946.
- ↑ 5.0 5.1 Kjellin, AP.; Ost, AE.; Pope, CE. (2005). "Histology of esophageal mucosa from patients with achalasia.". Dis Esophagus 18 (4): 257-61. doi:10.1111/j.1442-2050.2005.00478.x. PMID 16128783.