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Difference between revisions of "Achalasia"
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'''Achalasia''' is a benign pathology of the [[esophagus]]. | |||
==General== | |||
*Uncommon. | |||
*Risk factor for [[squamous cell carcinoma]] (in men and women) and [[esophageal adenocarcinoma|adenocarcinoma]] (in men).<ref>{{Cite journal | last1 = Zendehdel | first1 = K. | last2 = Nyrén | first2 = O. | last3 = Edberg | first3 = A. | last4 = Ye | first4 = W. | title = Risk of esophageal adenocarcinoma in achalasia patients, a retrospective cohort study in Sweden. | journal = Am J Gastroenterol | volume = 106 | issue = 1 | pages = 57-61 | month = Jan | year = 2011 | doi = 10.1038/ajg.2010.449 | PMID = 21212754 }}</ref> | |||
*Due to loss of ganglion cells.<ref name=pmid24395614>{{Cite journal | last1 = Blatnik | first1 = JA. | last2 = Ponsky | first2 = JL. | title = Advances in the Treatment of Achalasia. | journal = Curr Treat Options Gastroenterol | volume = | issue = | pages = | month = Jan | year = 2014 | doi = 10.1007/s11938-013-0007-2 | PMID = 24395614 }}</ref> | |||
Clinical: | |||
*Dysphagia (difficulty swallowing) liquids ''and'' solids.<ref name=pmid24395614/> | |||
DDx: | |||
*[[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> | |||
==Microscopic== | |||
Features:<ref name=pmid16128783>{{Cite journal | last1 = Kjellin | first1 = AP. | last2 = Ost | first2 = AE. | last3 = Pope | first3 = CE. | title = Histology of esophageal mucosa from patients with achalasia. | journal = Dis Esophagus | volume = 18 | issue = 4 | pages = 257-61 | month = | year = 2005 | doi = 10.1111/j.1442-2050.2005.00478.x | PMID = 16128783 }}</ref> | |||
*Mucosa typically normal - even in long-standing achalasia. | |||
Note:<ref name=pmid16128783/> | |||
*Achalasia seen in the context of a resection usually has inflammation. | |||
*Post-Heller myotomy often has inflammation. | |||
==Sign out== | |||
<pre> | |||
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. | |||
</pre> | |||
===Alternate=== | |||
<pre> | |||
GASTROESOPHAGEAL JUNCTION, BIOPSY: | |||
- COLUMNAR EPITHELIUM WITH MODERATE CHRONIC INFLAMMATION. | |||
- REACTIVE SQUAMOUS EPITHELIUM. | |||
- NEGATIVE FOR INTESTINAL METAPLASIA. | |||
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY. | |||
</pre> | |||
==See also== | |||
*[[Esophagus]]. | |||
==References== | |||
{{Reflist|2}} | |||
[[Category:Esophagus]] | |||
[[Category:Diagnosis]] | [[Category:Diagnosis]] | ||