GIT Disorders

Achalasia
Absent or ineffective peristalsis of the distal esophagus, accompanied by failure of the esophageal sphincter to relax in response to swallowing. is an esophageal motility disorder involving the smooth muscle layer of the esophagus and the lower esophageal sphincter. May progress slowly and occurs most often in people 40 years old.

 Persons with achalasia lack nonadrenergic, noncholinergic, inhibitory ganglion cells, causing an imbalance in excitatory and inhibitory neurotransmission. cause of most cases of achalasia is unknown

Manifestations
Primary symptom: difficulty in swallowing Sensation of food sticking in the lower portion of esophagus (if progresses) regurgitation of food Chest pain (cardio spasm) and heartburn (pyrosis) Pulmonary complications from aspiration of gastric juice

Assessment and Diagnostic findings

X-rays esophageal dilation above the narrowing at the gastroesophageal junction Barium swallow CT of the chest Endoscopy Manometry esophageal pressure is measured confirms the diagnosis

Treatment
Sublingual nifedipine significantly improves outcomes in 75% of people with mild or moderate disease. Surgical myotomy provides greater benefit than either botulinum toxin or dilation in those who fail medical management

Lifestyle changes
Both before and after treatment achalasia patients may need to: Eat slowly, chew very well, drink plenty of water with meals, and avoid eating near bedtime. Raising the head of the bed or sleeping with a wedge pillow promotes emptying of the esophagus by gravity

Medication
Drugs that reduce LES pressure are useful however, these drugs often stop helping after several months. Calcium channel blockers such as: Nifedipine Nitrates Isosorbide Botulinum toxin (Botox) may be injected into the lower esophageal sphincter to paralyze the muscles holding it shut

Pneumatic dilatation
the muscle fibers are stretched and slightly torn by forceful inflation of a balloon placed inside the lower esophageal sphincter.

Surgery
Heller Myotomy The myotomy is a lengthwise cut along the esophagus, starting above the LES and extending down onto the stomach a little way