Difference between revisions of "Achalasia"
Jump to navigation
Jump to search
(redirect) |
|||
| (4 intermediate revisions by the same user not shown) | |||
| Line 1: | Line 1: | ||
'''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> | |||
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. | |||
*[[Peroral endoscopic myotomy]] (POEM). | |||
*Laparoscopic myotomy. | |||
==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]]. | |||
*[[Esophageal stricture]]. | |||
*[[POEM]]. | |||
==References== | |||
{{Reflist|2}} | |||
[[Category:Esophagus]] | |||
[[Category:Diagnosis]] | [[Category:Diagnosis]] | ||
Latest revision as of 14:20, 14 January 2020
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.
- Peroral 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.