Achalasia cardiei

Achalasia cardiei

    * Introduction
    * Symptoms and Diagnosis
    * Treatment
Achalasia is a motor disorder of unknown origin characterized by relaxation insufucienta manometer or absence of lower esophageal sphincter-SEI, and the progressive disappearance of oesophageal peristalticii. The term that comes from the Latin for lack of relaxation and defines the main characteristic of the disease as a result patients will face difficulties swallowing.
The disease begins in people between 20 and 40 years, with a second peak of incidence at 60 years. All patients with achalasia shows dysphagia for solid foods, most developing dysphagia for liquids and varying degrees greutate.60 loss up to 90% of them spit undigested food shortly after masa.Regurgitarea can cause nocturnal cough and aspiration of food into the trachea. Between 30 and 50% of patients have chest pain associated with older alimentatia.Pacientii can experience these symptoms during several months or years before putting diagnosticului.Complicatiile include weight loss, cough, bronchospasm, and aspiration pneumonia.
Achalasia is suspected frequency of medical history pacientului.In initial stages of the disease, radiographs may be normala.In toracioca the disease in late stages megaesofagul seen on x-ray-esophageal dilatation filled with liquid and swallowed air, drawing a fluid level aeric caracteristic.Pacientii old with a long history of the esophagus in achalasia may be bird beak baritat.Manometria examination usually reveals abnormal esophageal motility.
Treatment using SEI-pressure drop medicamentecare many anticholinergic, beta-2 agonists, nitroglicerina.Toxina endoscopic injection of botulinum can be effective in SEI.Alte as effective methods include esophageal dilatation balloon and mitomia SEI.40% of patients underwent procedures Expansion repetate.Cele most important complications are: perforation, severe dysphagia or esophageal reflux disease.
Pathogenesis
SEI relaxation and contraction is controlled by excitatory neurotransmitters (substance P, acetylcholine) and inhibitors (nitric oxide, VIP). Cardiei People who have disorders, lack these neurotransmitters, resulting in a hypertensive esophageal sphincter, nerelaxat.
Such food can not pass in stomac.La ingurgitate half of patients with incompetent SEI is observed and no normal-peristaltic contractions of the lower half of the esophagus, with the cessation of wave formation drivers of food to the stomach.
The causes of these abnormalities in esophageal motility are necunoscute.Anumite theories indicate the involvement of infections, immune disorders or heredity in the etiology acesteia.Acalazia muscles but also affects the nervous control component stages debut acestora.In acalaziei microscopically observed signs of inflammation muscles of the lower esofaguluio, especially around nervoase.Pe endings as the disease progresses, the nerves degenerate and disappear, especially those that control relaxation and degeneration is observed also SEI.De miocitelor.Rezultatul these transformations is the lack of relaxation and lack of initiation SEI esofagului.Cu peristalticii time in the lower half of the body to dilate the esophagus.