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| ==Achalasia== | | ==Achalasia== |
| ===General===
| | {{main|Achalasia}} |
| *Uncommon.
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| *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>
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| *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>
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| Clinical:
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| *Dysphagia (difficulty swallowing) liquids ''and'' solids.<ref name=pmid24395614/>
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| DDx:
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| *[[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>
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| ===Microscopic===
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| 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>
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| *Mucosa typically normal - even in long-standing achalasia.
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| Note:<ref name=pmid16128783/>
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| *Achalasia seen in the context of a resection usually has inflammation.
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| *Post-Heller myotomy often has inflammation.
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| ===Sign out===
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| <pre>
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| ESOPHAGUS, BIOPSY:
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| - SQUAMOUS EPITHELIUM WITH A MILD DEEP LYMPHOCYTIC INFILTRATE, EDEMA, AND
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| REACTIVE CHANGES, NO EOSINOPHILS APPARENT.
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| - SCANT COLUMNAR EPITHELIUM WITH MINIMAL STROMA, NO APPARENT SIGNIFICANT PATHOLOGY.
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| - NEGATIVE FOR INTESTINAL METAPLASIA.
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| - NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.
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| </pre>
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| ====Alternate====
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| <pre>
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| GASTROESOPHAGEAL JUNCTION, BIOPSY:
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| - COLUMNAR EPITHELIUM WITH MODERATE CHRONIC INFLAMMATION.
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| - REACTIVE SQUAMOUS EPITHELIUM.
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| - NEGATIVE FOR INTESTINAL METAPLASIA.
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| - NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.
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| </pre>
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| ==Esophageal inlet patch== | | ==Esophageal inlet patch== |