The most comprehensive mind map of "Clinical Diagnosis and Treatment of Achalasia", quickly collect it

It is only for medical professionals to read and recommend collections! Achalasia, also known as cardia spasm and megaesophagus, is a disease caused by neuromuscular dysfunction in the esophagus.
Its main characteristics are weakened esophageal peristalsis, high pressure in the lower esophageal sphincter (LES) and weakened relaxation response to swallowing actions.

The clinical manifestations include dysphagia, food reflux and post-sternal discomfort, as well as cough and lung infections caused by misinhalation of food reflux into the trachea.

If the disease is not treated in time, there is a potential risk of esophageal cancer.

Unexplained dysphagia, food reflux, and posterior sternal pain are important evidences for the clinical diagnosis of this disease.
If X-ray esophageal barium swallowing examination, endoscopy, esophageal pressure measurement, etc.
are used to rule out "nutcracker" esophagus, diffuse Esophageal spasm and other diseases can be diagnosed.

The neurodegenerative damage of this disease cannot be corrected for the time being.
The focus of the treatment of this disease is to relieve LES relaxation disorder to varying degrees, reduce LES pressure, and make LES completely relax during swallowing so that food can enter the stomach smoothly.

 In terms of treatment, non-surgical treatment, dilation or surgical treatment should be selected as appropriate.

Drug therapy commonly used nitrates and calcium ion antagonists are mainly suitable for cases with mild to moderate dysphagia and the preparation stage before dilation or cardia myotomy.

 Both dilatation and cardia myotomy can achieve good results, but the dilatation therapy does not damage the elasticity of the LES, is simple and easy to implement, has fewer complications, less patient pain, quick recovery, and light economic burden.

Therefore, if there is no contraindications such as supraphrenic diverticulum, past esophageal perforation, adjacent aortic aneurysm, dilatation therapy is preferred.

References: [1] Yu Jieping, Shen Zhixiang, Luo Hesheng.
Practical Digestive Diseases (3rd Edition) [M].
Beijing: Science Press, 2017.
[2] ISDE.
The 2018 ISDE achalasia guidelines[J].
Dis Esophagus.
2018 Aug 30.
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