Akalasia is a condition of loss of the ability of esophagus to push food or drink from mouth to stomach. This disease is a rare disease and can affect people of all ages, both men and women.
Causes of Akalasia
Akalasia occurs when the nerves in the esophagus wall connecting the mouth with the stomach are damaged and stop functioning normally. Generally, the lower esophageal sphincter (LES) will open automatically for food to enter the stomach. But in people with the secret, LES does not open and close normally, so the food accumulates at the bottom of the esophagus or rise back to the base of the esophagus.
The main cause of damage to LES is not known for certain. However, there are several factors that allegedly have the potential to increase the risk of occurrence of secrecy, among others:
- Immune system disorders. Akalasia is thought to be caused by an immune system that attacks the nerve cells of the esophagus, causing the throat nerve to decrease in function.
- Hereditary factors. Akalasia is allegedly inherited from an elderly parent.
- Virus infection. For example the herpes virus.
Symptoms of Acalasia
Symptomatic symptoms occur gradually. Over time, the function of the esophagus will be weaker and there are some symptoms as follows:
- Dysphagia, a condition when the sufferer of the confusion difficulties, even the pain, when swallowing food or drink.
- Heartburn , is a feeling of heat or pain in the pit of the stomach due to stomach acid that rises into the esophagus.
- Regurgitation, a condition when food or drink goes back up the throat.
- Chest pain.
- Vomiting that drips or drips from the mouth.
- Weight loss.
If symptoms of secretion continue to be left without treatment, it will increase the risk of esophageal cancer .
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Diagnosis of Akalasia
Akalasia has symptoms similar to other symptoms of gastrointestinal disorders. As a first step, the doctor will examine the medical history and symptoms that patients feel. Then, the doctor will perform a physical examination primarily to see the swallowing function of the patient.
To confirm the diagnosis, your doctor may perform further examination, including:
- Esofagography. One type of imaging test to get a detailed picture of the esophagus. Patients will be asked to swallow a coloring fluid (contrast) containing barium, so that the esophagus can be seen clearly when the X-ray. Normally, the throat diameter appears to be wide enough and barium appears smoothly entering the stomach. However, it is not so in the sufferer of the confidential.
- Manometry. Small plastic tubes and flexible will be inserted into the esophagus through the nose. This tool will record the activity and strength of muscle contraction, and check the pressure that appears in the LES.
- Endoscopy. A flexible instrument with a camera at the end will be inserted into the lower portion of the esophagus so that the doctor can check the condition of the esophagus wall and stomach.
Confidentiality treatment aims to reduce the symptoms felt by the patient, open the LES muscle so that food and drinks can enter easily into the stomach, and prevent complications. There are several types of treatment for the sufferer of the confidential, among others:
- The spread of the esophagus. This procedure is done by inserting a balloon into the narrowing of the esophagus with the help of endoscopy. The balloon is then developed to enlarge the opening of the LES, so that food can enter the stomach. This action needs to be done repeatedly to get the best results.
- Injection of botox (botulinum toxin). This type of treatment is performed for patients with general health conditions is not good, so it is not possible to do the action of esophagus widening. The doctor will inject botox directly into the LES through the endoscope, so the LES will relax and open. The effect of botox injection is only temporary, it can last for several months and sometimes several years.
- Operation. The surgical procedure for opening LES is known as myotomy . There are several types of myotomy surgery to deal with confidential, among others:
- Heller myotomy. This procedure is done by cutting LES muscles using laparoscopic techniques or surgery with minimal incisions, so the food is easier to enter the stomach.
- Peroral endoscopic myotomy (POEM). This procedure is performed by using an endoscope that is inserted through the mouth to the esophagus to bypass the LES.
- Fundoplication. The surgeon will wrap the top of the stomach (below from the LES) to tighten the stomach muscles and prevent the rise of stomach acid. This surgical procedure is usually performed in conjunction with Heller myotomy through laparoscopic technique.
In addition, the administration of drugs may also be performed by a doctor if the patient's condition is not possible to pass through esophageal or surgical procedures, and if botox injections are also unhelpful. Drugs that can be given to relax LES include nitroglycerin or nifedipine, which is consumed before meals.
Complications of Akalasia
There are several complications that can be experienced by the sufferer of secrets, among others:
- Aspiration pneumonia, occurs when food or fluid enters the lungs and causes infection.
- Perforation of the esophagus, the condition of torn wall esophagus or esophagus. Esophageal perforation can cause life-threatening infections of the patient.
- Esophageal cancer. Akalasia is at risk of developing esophageal cancer.
Prevention of Akalasia
Akalasia is difficult to prevent, but patients can prevent complications, including by:
- Drinking while eating.
- Chew food well before ingestion.
- Going on a diet with small portions and more often.
- Avoid eating before bedtime, give a minimum of 3 hours before bedtime.
- Avoid sleeping in a flat position. Use a pillow to support the head, this is done to prevent stomach acid from rising into the esophagus.
- Quit smoking.