https://wikem.org/w/index.php?action=history&feed=atom&title=Achalasia%2FenAchalasia/en - Revision history2026-04-18T09:52:39ZRevision history for this page on the wikiMediaWiki 1.38.2https://wikem.org/w/index.php?title=Achalasia/en&diff=379404&oldid=prevFuzzyBot: Updating to match new version of source page2026-01-06T17:05:57Z<p>Updating to match new version of source page</p>
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==Background==<br />
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[[File:Gray1032.png|thumb|Posterior view of the position and relation of the esophagus in the cervical region and in the posterior mediastinum.]]<br />
[[File:Layers of the GI Tract english.svg|thumb|Layers of the GI track: the mucosa, submucosa, muscularis, and serosa.]]<br />
[[File:Illu esophagus.jpg|thumb|Esophagus anatomy and nomenclature based on two systems.]]<br />
*Inability of LES to relax and loss of normal peristalsis <ref>Krill JT, Naik RD, Vaezi MF. Clinical management of achalasia: current state<br />
of the art. [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4831602/ Clin Exp Gastroenterol. 2016 Apr 4;9:71-82.]</ref><br />
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==Clinical Features==<br />
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*[[Special:MyLanguage/Dysphagia|Dysphagia]]<br />
*Regurgitation<br />
*[[Special:MyLanguage/Chest pain|Chest pain]]<br />
**Esophageal spasm can feel like tight, crushing retrosternal pain similar to ACS<br />
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==Differential Diagnosis==<br />
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*[[Special:MyLanguage/Ingested foreign body|Ingested foreign body]]<br />
*Esophageal carcinoma - ''dysphagia predominantly for solid foods during initial stages''<br />
*Reflux [[Special:MyLanguage/esophagitis|esophagitis]] - ''dysphagia results from inflammatory swelling or a fibrotic stricture''<br />
*Pseudoachalasia - ''underlying malignancy mimics achalasia''<br />
*[[Special:MyLanguage/Connective tissue disorders|Connective tissue disorders]] - ''e.g. [[Special:MyLanguage/scleroderma|systemic sclerosis]]''<br />
*Esophageal spasm - ''chest pain a predominant feature''<br />
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==Evaluation==<br />
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*Upper GI<br />
**Esophageal dilatation<br />
**Birds beak sign <br />
[[File:Birds Beak.JPG|thumbnail|Barrium swallow showing birds beak appearance]]<br />
*Esophageal Manometry<br />
[[File:Manometry.jpg|thumbnail|Aperistaltic contractions, increased intraesophageal pressure, and failure of relaxation of the lower esophageal sphincter.]]<br />
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==Management==<br />
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*Trial of antispasmodic for esophageal spasm <br />
**[[Special:MyLanguage/Nifedipine|Nifedipine]]<br />
*Surgical intervention<br />
**Balloon dilatation<br />
**Botulinum toxin injection <ref>Nassri A, Ramzan Z. Pharmacotherapy for the management of achalasia: Current status, challenges and future directions. World J Gastrointest Pharmacol Ther. [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4635155/ 2015 Nov 6;6(4):145-55.]</ref><br />
**Myomectomy<br />
**Consider gastrostomy for frail and older patients<br />
*Patients need to eat upright at all times.<br />
*Treatment may improve dysphagia, but there is no cure and swallowing never completely normalizes<br />
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==Disposition==<br />
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==See Also==<br />
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*[[Special:MyLanguage/Ingested foreign body|Ingested foreign body]]<br />
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==External Links==<br />
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==References==<br />
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[[Category:GI]]</div>FuzzyBot