Achalasia: Difference between revisions

(4 intermediate revisions by the same user not shown)

Line 1:

~~#redirect~~ [[~~Esophagus#Achalasia~~]]

'''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==

[[Category:Esophagus]]

[[Category:Diagnosis]]

@@ Line 1: / Line 1: @@
-#redirect [[Esophagus#Achalasia]]
+'''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]]

Achalasia: Difference between revisions

Navigation menu

Search