Achalasia and primary esophageal motility disorders
Causes and risk factors
It affects men and women of almost all ages equally, especially between the ages of 30 and 60 with a peak around 40. The incidence is about 8 cases per 100,000 inhabitants per year.
Which are the symptoms?
- Dysphagia (sensation of obstructed transit of food through esophagus) that first arises in episodes, then constantly. Didactically it is called 'paradoxical' because it is often more pronounced for liquids than for solids.
- Retrosternal pain.
- Regurgitation (return to the mouth, without gagging, of undigested material, characteristically non-acidic because it has never reached the stomach).
- Significant weight loss, closely related to the course and duration of the disease.
How is it diagnosed?
Diagnosis is possible by esophagogastroduodenoscopy, the radiologic study of esophageal transit, and esophageal manometry.
How is it treated?
- Pharmacological therapy: drugs that reduce the tone of the lower esophageal sphincter are administered, in particular calcium antagonists possibly associated with nitrates.
- Mechanical dilatation: pneumatic balloons are inflated under endoscopic control at the level of the cardial junction (which separates the esophagus from the stomach) until they tear the muscle fibers of the lower esophageal sphincter and allow the subsequent passage of food into the stomach.
- Botulinum treatment: the injection of botulinum toxin at the level of the lower esophageal sphincter carried out endoscopically; it is an effective treatment, easy to perform and without risks for the patient. The treatment must, however, be repeated several times and its long-term effectiveness is not yet known.
- Surgical therapy: extramucosal myotomy according to Heller combined with an antireflux plastic guarantees the best result. This technique can be performed according to the traditional approach or by laparo/thoracoscopic approach.