questions 3

Achalasia

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Topic updated on 11/20/16 1:00pm

Introduction
  • motor disorder of the distal esophagus caused by degeneration of Auerbach's (myenteric) plexus 
    • the most common motility disorder
  • Pathophysiology
    • autoimmune process leads to  loss of nitric oxide (NO) producing neurons which normally relax the sphincter muscles
      • there is an association with HLA-DQw1 
    • leads to failure of the LES to relax during swallowing
    • result is loss of peristalsis
  • Associated conditions
    • Chagas' disease
      • amastigotes destroy ganglion cells
    • scleroderma (present in 70% of patients with scleroderma)
Presentation
  • Symptoms
    • dysphagia for solids and liquids
    • nocturnal regurgitation of food
    • weight loss
Evaluation
  • Barium swallow
    • will show
      • narrowing of the distal esophagus
        • "bird's beak" appearance
      • loss of peristalsis in the distal two thirds
      • dilated proximal esophagus
  • Manometry studies 
    • will show
      • increased LES pressure
      • diffuse esophageal spasm
Differential
  •  Esophageal dysmotility
    • also seen in Systemic sclerosis or CREST syndrome 
Treatment
  • Pharmacologic
    • medications that reduce LES tone
      • medicaitons include
        • nifedipine
        • long acting nitrates
        • botulinum toxin injection
  • Surgical
    • endoscopic balloon dilation of LES
Complications
  • Esophageal carcinoma
    • ↑ risk of esophageal squamous cell carcinoma secondary to chronic irritation from food stasis


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(M1.GI.84) A 48-year-old female visits your office complaining that she has trouble swallowing solids and liquids, has persistent bad breath, and sometimes wakes up with food on her pillow. Manometry studies show an absence of functional peristalsis and a failure of the lower esophageal sphincter to collapse upon swallowing. The patient’s disorder is associated with damage to which of the following? Topic Review Topic

1. Lamina propria
2. Submucosa
3. Myenteric (Auerbach’s) plexus
4. Submucosal (Meissner’s) plexus
5. Muscularis mucosa

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