Achalasia
Achalasia is a
swallowing disorder caused by loss of function in the lower esophageal
sphincter (the muscular ring at the junction of the esophagus and the stomach).
Normally, when people swallow, the sphincter relaxes to allow food and liquid
to pass into the stomach. With achalasia, the sphincter does not relax, which
causes food to be lodged in that area.
Symptoms of Achalasia
Achalasia can
cause these symptoms:
·
Coughing
·
Choking
·
Regurgitation
·
Dysphagia
·
Food retention in the esophagus
Achalasia Diagnosis
Because achalasia
is one of a number of swallowing disorders, physicians at Johns Hopkins will
use diagnostic procedures to determine that achalasia is the cause of your
symptoms.
Physicians at
Johns Hopkins are recognized for their experience and expertise in diagnosing
and treating achalasia so you can count on them to develop a treatment plan
that will alleviate your symptoms.
Your first
appointment will include a thorough physical examination and recording your
medical history.
Diagnostic
procedures your doctor may order include:
·
24-hour pH Impedance
Endoscopy
Gastroenterologists
at Johns Hopkins routinely perform endoscopies, a frequently used diagnostic
procedure for swallowing disorders. Their vast experience with these tools
allows for an accurate diagnosis.
Your doctor may
perform an endoscopy to examine the esophagus and stomach. An endoscope is a
thin, lighted tube with a camera at its tip that allows your doctor a better
view of your condition.
During an endoscopy:
·
You are sedated.
·
Your doctor inserts a flexible endoscope through
your mouth and into your esophagus.
·
The endoscope allows your doctor to examine your
stomach, duodenum (first part of your small intestine) and esophagus.
·
Your doctor looks for abnormalities in the
mucous lining (e.g., esophageal strictures [narrowing] or tumors).
·
If necessary, your doctor can perform a biopsy
or remove abnormal tissue for further analysis.
Esophageal Manometry
An esophageal
manometry evaluates the changes in pressure that happen when you
swallow. During an esophageal manometry:
·
Your doctor will pass a thin, flexible catheter
through your nose or mouth, down your throat and into your stomach. While it
can be slightly uncomfortable to have a tube in your nose, the test only lasts
about 10 minutes.
·
Attached to the tube are a number of pressure
sensors.
·
Using the pressure sensors, your doctor can
assess your swallowing muscles in action.
·
You start by swallowing a few sips of water,
followed by applesauce or something similar.
·
You may bring foods that trigger your symptoms;
this way, your doctor can see what is happening in real-time.
Esophageal
manometry provides your doctor with real-time information about:
·
Strength and coordination of the muscle
movements (peristalsis) of the pharynx and esophagus.
·
Strength and relaxation function of the upper
and lower esophageal sphincters. A sphincter is a muscle that opens and closes;
the lower esophageal sphincter is the muscle that controls the emptying of
foods from the esophagus to the stomach.
Wireless pH Testing
Wireless pH
testing allows your doctor to evaluate your reflux activity over a 48-hour
period, while you are continuing your normal activities. To perform wireless pH
testing:
·
Your doctor performs an endoscopy and places a
small chip in the lower esophagus.
·
The chip records acid at that site for 48 hours.
·
The chip transmits your acid level to a wireless
recording device that you wear on a belt.
·
The recording device is sent to your doctor who
downloads the data and can gauge your reflux severity.
Treatment
Treating
achalasia focuses on procedures that enable the esophageal sphincter to relax
and allow food to pass through, offering patients relief from symptoms that
make eating difficult. Your doctors at Johns Hopkins may recommend dilation,
surgery or an injection, depending on your symptoms and diagnosis.
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