Gullet achalasia – the disease which is characterized by lack of reflex disclosure of the cardia when swallowing. The disease is followed by decrease in a tone of chest department of a gullet and disturbance of a vermicular movement of intestines.
For the first time the disease was described in 1672. Statistically, a disease 1 person from 100 thousand has. Most often the achalasia of a gullet meets at the age of 40-50 years. The gullet achalasia at children – quite unusual occurrence also makes about 3,9% among all cases of diseases. Women, as a rule, have this disease several times more often than men.
The exact reason promoting developing of an achalasia of a gullet is unknown. Infectious diseases, an outside prelum of a gullet, inflammatory processes, malignancies, infiltrative defeats, etc. belong to the most frequent reasons.
The achalasia of a gullet is most often diagnosed for children after five-year age. On emergence of the first symptoms, as a rule, nobody turns special attention therefore diagnose a disease with delay. The most common symptoms of an achalasia of a gullet at children are the dysphagy and vomiting right after meal.
The dysphagy is the most important symptom of an achalasia. The dysphagy practically occurs at all patients with this disease. As a rule, the time interval between manifestation of the first symptoms of a disease and time of the address to the doctor varies within 1-10 years.
Symptom of an achalasia, the second for frequency, is regurgitation of the remains of food without impurity of an acid gastric juice and bile as a result of stagnation of contents in a gullet. It leads to the fact that patients often test at night attacks of suffocation or cough.
Also heartburn and thorax pains belong to symptoms of an achalasia. Pains are preferential localized behind a breast, have the squeezing or squeezing character and often give to a back, a mandible or a neck. Happens, in the presence of heartburn instead of a gullet achalasia make to the patient the wrong diagnosis, for example, a gastroesophagal reflux. However heartburn at an achalasia does not arise after meal and does not cease at use of antiacid drugs.
The achalasia of a gullet leads to irreversible changes in nervous and other systems of an organism.
The most widespread complications of a disease are:
At it is long the existing achalasia the gullet is inclined to extend significantly that leads to thinning of its walls therefore there are above described complications of a disease.
Approximately at 85% of patients with an achalasia essential decrease in body weight is noted.
At different stages of an achalasia there is only an obstruction of the cardia with insignificant dilatation of proximal department. In process of progressing of a disease on X-ray it is possible to see characteristic signs: an esophagectasia, in a lower part clinical narrowing on a small extent with coronoid expansion on site the narrowed department. In spite of the fact that the clinical picture of a disease is quite characteristic, often at patients aged after 50 years it can be confused with gullet cancer, especially at its early stages.
The greatest advantage in diagnosis of an achalasia is rendered by an ezofagoskopiya. Confirmation of clinical displays of an achalasia is studying of motive function of a gullet. In a gullet low pressure with dilatation of its gleam and lack of a vermicular movement after swallowing is found. Throughout a gullet after swallowing there is a rise in pressure. During swallowing the ezofagealny sphincter does not reveal that gives the chance with an accuracy to speak about the diagnosis of an achalasia.
At some patients disturbance of a vermicular movement of a gullet passes into a diffusion spasm, and in response to the act of swallowing there are repeated strong spasms.
The achalasia of a gullet will very badly respond to drug treatment. Drug treatment of an achalasia is applied unless to relief of symptoms of a disease. To the patient appoint a sparing diet, sedatives, complexes of vitamins, antispastik. As a rule, medicamentous therapy gives only temporary relief.
The forced expansion of the cardia is possible due to use of the mechanical, pneumatic or hydrostatic dilatator. The greatest distribution was gained by pneumatic dilatators as the safest.
Under radiological control enter the probe with a cylinder on the end into a stomach. In a stomach gleam the cylinder is inflated by air and extended outside. It allows to expand a gullet gleam. Ruptures of a wall of a gullet or mucous can arise when using the elastic dilatator approximately in 1% of cases whereas when using mechanical the percent increases to 6. Approximately in 80% of cases dilatation renders positive effect and successfully saves the patient from burdensome symptoms of an achalasia.
If dilatation does not yield a positive take, surgical treatment of an achalasia can be applied. The most widespread modern operational method of treatment of an achalasia of a gullet is bilateral cardiomyotomy. Operation consists of a longitudinal section of muscular layers of distal department of a gullet. Sometimes there is enough only a front cardiomyotomy.
After this operation about 90% of patients recover. Unsatisfactory results are connected preferential with scarring in the remote terms. This operation is most a procedure of choice of treatment of an achalasia of a gullet at children at the started stages.
In Great Britain there is a law according to which the surgeon can refuse to do to the patient operation if he smokes or has excess weight. The person has to refuse addictions, and then, perhaps, he will not need an operative measure.
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