Achalasia (Disorder of the oesophagus) (Health education (Avoid food and…
Achalasia (Disorder of the oesophagus)
A chronic progressive condition in which the tone in the lower two thirds of the oesophageal musculature is increased, resulting in the sphincter failling to relax, thus delaying the passage of the swallowed food into the stomach, while the peristalsis in the oesophagus is ineffective, weak or absent. This results in the accumulation and stagnation of food and fluids in the oesophagus, causng inflammation and mucosal irritation.
Degenerative changes in the ganglion cells or impairment of impulses from the Auerbach's plexus that innervates the muscle tissue of the oesophagus.
In achalasia, there is increased tone of lower oesophageal sphincter, due to the defectiive innervation by the Auerbach's plexus with the resultant failure of normal peristalsis in the lower two thirds of the oesophagus.
This results in poor tone and peristalsis, distention of the lower part of the oesophagus and delayed emptying of the oesophagus into the stomach.
Assesment findings and symptoms
Progressively increasing dificulty in swallowing both solids and liquids and feeling of something stuck on the throat.
In early stages the patient may complain of heartburn in the substernal region which results from the spasm of the oesophagus.
Other commplaints may include inability to blech, regurgitation of undigested food and persistent cough especially at night
Reccurent upper respiratotory tract infections, overeacting and emotinal disturbances, weight loss may be present
Diagnostic tests and findings
Chest X-ray may show the enlarged fluid filled oesophagus.
Oesophogoscopy will show widening of the oesophagus.
A biopsy will be taken to exclude oesophageal cancer.
Examination will be done to rule out the scleroderma, which is the disorder that impairs swallowing.
Calcium channel blockers (e.g nifedipine) and nitrates (nitroglycerin) to decrease oesophageal presure and improve swallowing.
Frequent doses of antacids to neutralise gastric contents.
oesophago- myotomy which is the dilation of the oesophageal sphicter, or enlargement of the sphincter.
The sphincter may be opened machanically by inflating the balloon inside it.
Avoid food and beverages that give you heartburn.
Drink plenty of water when eating and chew well.
Avoid eating for 3 hours before going to bed.