Fig 2 - available via license: Creative Commons Attribution 4.0 International
Content may be subject to copyright.
Radiological appearance on barium swallow of different stages of achalasia: a stage I, b stage II, c stage III, d stage IV
Source publication
A precise diagnosis is key to the successful treatment of achalasia. Barium swallow, upper endoscopy and high-resolution manometry provide the necessary information about a patient's anatomy, absence of other diseases, and type of achalasia (I, II, III). High-resolution manometry also has prognostic value, the best results of treatment being obtain...
Context in source publication
Context 1
... be enough to fill a possibly enlarged esophagus [14]. We can distinguish between four stages of achalasia based on the maximum diameter and shape of the esophagus on barium swallow: stage 1 B 4 cm; stage 2 = 4-6 cm; stage 3 C 6 cm, with a straight esophagus; and stage 4 C 6 cm, with a sigmoid-shaped esophagus (end-stage disease) [15,16] (Table 1, Fig. ...
Similar publications
Background and study aims Knowledge on self-reported quality of life (QoL) in achalasia and QoL improvements after peroral endoscopic myotomy (POEM) is limited. Furthermore, the clinical role of QoL in achalasia follow-up has not been evaluated. The present study aimed to examine QoL in achalasia patients before and after POEM and assess associatio...
Citations
... During diagnostic workup for achalasia cardia, clinical history and examination findings are complemented by Upper Gastrointestinal Endoscopy, Barium Swallow, and Esophageal manometry. 10,11 Upper Gastrointestinal Endoscopy is vital to exclude other benign causes of dysphagia and malignant causes of dysphagia and lower esophageal obstruction. Findings in achalasia may include a dilated or tortuous esophagus with saliva and/or food retention, as well as a tight esophageal gastric junction; no visible cause of esophageal obstruction is noted. ...
... Findings in achalasia may include a dilated or tortuous esophagus with saliva and/or food retention, as well as a tight esophageal gastric junction; no visible cause of esophageal obstruction is noted. 10,11 However, due to the low sensitivity of endoscopy, especially in early disease, it yields normal findings in nearly 40% of the patients. 12 Barium swallow is an invaluable primary diagnostic tool in low-and middle-income-income countries (LMICs) because it is more available and less expensive. ...
... The classic finding in esophageal achalasia is what is known as the bird's beak appearance; a dilated esophagus with progressive narrowing, as well as lack of peristalsis. 10,11 Barium swallow may show normal findings in nearly 40% of patients with Achalasia. 13 The gold standard for the diagnosis of achalasia remains High-resolution esophageal manometry. ...
... × см × с [6]. Комплексное обследование пациента с подозрением на ахалазию пищевода (ЭГДС, рентгенологическое исследование верхних отделов ЖКТ с пероральным контрастированием и манометрия пищевода высокого разрешения) -это залог успешного лечения, так как позволяет исключить другие заболевания, своевременно выявить осложнения, определить прогноз заболевания (наилучшие результаты лечения достигаются при ахалазии пищевода II типа по Чикагской классификации) [20,21]. Компьютерная томография грудной и брюшной полостей и эндоскопическое ультразвуковое исследование показаны при подозрении на злокачественное новообразование. ...
Cardiomyotomy (in particular, oral endoscopic cardiomyotomy) is the most effective method of treating achalasia of the esophagus cardiac part, however, in some cases patient complaints persist or symptoms relapsed. This conditioned the need to perform the complex examination of a patient for the correct diagnostics of this disease, prognose assessment and treatment tactics determination as well as the identification of the causes of the persistence or resumption of clinical manifestations after surgical treatment.
... Diagnosis of achalasia is made difficult by the fact that achalasia generally has an insidious onset. Many patients are first diagnosed with gastroesophageal reflux disease and treated as such, which often goes on for years, prior to a conclusive diagnosis of achalasia [12]. ...
... Types 2 and 3 achalasia also exhibit abnormal IRP and 100% failed peristalsis but with additional features. In type 2 achalasia, over 20% of swallows show pan-esophageal pressurization, while in type 3 achalasia, more than 20% of swallows exhibit premature or spastic contractions [12]. In this case, the patient showed no abnormal pan-esophageal pressurization or premature contractions ( Table 2), but did display an abnormal IRP ( Table 1) and 100% failed peristalsis ( Table 2), thus confirming the diagnosis of type 1 achalasia. ...
A 14-year-old girl with a history of asthma was hospitalized because of sudden-onset back pain around her thoracic region that spread to her chest and abdomen. She had been experiencing dysphagia and breathing difficulties for two years, especially after overeating, which often resulted in vomiting undigested food. CT imaging revealed a severely dilated esophagus narrowing at the gastroesophageal junction, suggestive of type 1 achalasia. Further testing confirmed the diagnosis, with an esophageal manometry showing a lack of esophageal contractions and sphincter relaxation. She then underwent a laparoscopic Heller myotomy with relief to her symptoms. This case underscores the rarity of pediatric-onset achalasia with significant esophageal dilation and secondary airway compression, presenting with unusual musculoskeletal and respiratory symptoms. Timely diagnosis and treatment are crucial to prevent worsening and complications.
... Apatinio stemplės sfinkterio atsipalaidavimas laikomas sutrikusiu, kai integruotas atsipalaidavimo slėgis, išmatuotas per 4 sekundžių intervalą, yra didesnis nei 15 mmHg. Jei tuo pačiu metu atsiranda stemplės kūno peristaltika arba jos trūksta, diagnozuojama achalazija [14]. ...
... Neretai diferencijuojant achalaziją, pseudoachalaziją ir kitas ligas, atliekamas ir kompiuterinės tomografijos tyrimas. Sergant pirmine achalazija, stebimas lygus susiaurėjęs segmentas, sergant antrine arba pseudoachalazija šis segmentas yra netolygus [14]. ...
Straipsnyje aprašomas klinikinis atvejis, kai po laparoskopinės skrandžio apjuosimo reguliuojama juosta operacijos pacientei išsivystė pseudoachalazija, pateikiama lyginamoji achalazijos ir pseudoachalazijos literatūros apžvalga. 56 metų moteris ne kartą kreipėsi į gastreoenterologą dėl ilgą laiką trukusių skausmų epigastriumo srityje, už krūtinkaulio, vėmimo po valgio. Po keleto atliktų ezofagogastroduodenoskopijų, rentgenokontrastinių tyrimų, diagnozuota achalazija. Stacionarinio ištyrimo metu buvo patikslinta, kad skrandį apjuosianti reguliuojama juosta sukėlė pseudoachalaziją. Achalazija yra stemplės motorikos sutrikimas, pasireiškiantis sutrikusia stemplės peristaltika ir daline arba visiška apatinio stemplės sfinkterio disfunkcija ryjant. Ši patologija yra ganėtinai reta. Etiologija nėra aiški. Diferencinę diagnostiką sunkina panašūs achalazijos, pseudoachalazijos ir gastroezofaginio refliukso simptomai, ezofagogastroduodenoskopijos, rentgenokontrastinių tyrimų, manometrijos ir kompiuterinės tomografijos rezultatai. Tyrimų duomenimis, saugiausias achalazijos gydymo metodas − peroralinė endoskopinė miotomija. Pseudoachalazija gydoma šalinant ją sukėlusią priežastį.
... Achalasia is one of the most common esophageal motility disorders, affecting approximately 1 in 100,000 individuals a year [1 ,2] . It is usually diagnosed between 20 and 50 years of age but can occur at any age with no predilection for either sex [1][2][3] . The etiology of achalasia is still vague, and its precise pathogenesis remains ambiguous to this day [3][4][5] . ...
Achalasia is one of the most common esophageal motility disorders. Typical symptoms include dysphagia, food regurgitation, respiratory symptoms, chest pain, and weight loss. Respiratory obstruction due to tracheal compression by the massively dilated esophagus is a very rare but fatal complication. A 36-year-old male presented with progressive respiratory distress with a history of untreated dysphagia and regurgitation. Further diagnosis revealed dilatation of the esophagus with undigested food. A Heller myotomy with fundoplication was performed and respiratory symptoms were relieved. Tracheal compression and acute airway obstruction caused by esophageal dilatation in achalasia is a rare presentation. Early recognition of this rare manifestation is critical and emergency treatment is necessary for life saving. Radiological examination can help physicians find the dilated esophagus. Respiratory symptoms resulting from tracheal compression by a dilated esophagus rarely occurred. Even though physicians should be alert and early decompression has to be performed immediately.
... Another health condition affecting the oesophagus is achalasia in which the lower oesophageal muscles fail to relax which restricts the passage of food to the stomach. 21 Furthermore, dysmotility is a dysfunction in which contraction from the oesophageal muscles are impaired resulting in imbalanced and uncoordinated peristaltic movement, leading to gutrelated diseases. 22 The peristaltic movement of the oesophagus is an important physiological process transporting food into the stomach and any disorder can be harmful. ...
... Oesophageal manometry is traditionally performed using tethered devices to monitor the oesophagus for movement of food towards the stomach by measuring the pressure applied by the peristaltic movements. 21 A wireless capsule (24 mm×Ø 12 mm) has measured the peristaltic pressure in a beagle dog for 26-hour period, which showed that a smart capsule can be used for longterm monitoring as opposed to tethered devices. 102 Another capsule prototype with better sensor power consumption allowed measurement of gut parameters including peristaltic pressure through a full gut transit, with the authors claiming that the smart capsule had a battery life of 233 hours. ...
Smart capsules are developing at a tremendous pace with a promise to become effective clinical tools for the diagnosis and monitoring of gut health. This field emerged in the early 2000s with a successful translation of an endoscopic capsule from laboratory prototype to a commercially viable clinical device. Recently, this field has accelerated and expanded into various domains beyond imaging, including the measurement of gut physiological parameters such as temperature, pH, pressure and gas sensing, and the development of sampling devices for better insight into gut health. In this review, the status of smart capsules for sensing gut parameters is presented to provide a broad picture of these state-of-the-art devices while focusing on the technical and clinical challenges the devices need to overcome to realise their value in clinical settings. Smart capsules are developed to perform sensing operations throughout the length of the gut to better understand the body’s response under various conditions. Furthermore, the prospects of such sensing devices are discussed that might help readers, especially health practitioners, to adapt to this inevitable transformation in healthcare. As a compliment to gut sensing smart capsules, significant amount of effort has been put into the development of robotic capsules to collect tissue biopsy and gut microbiota samples to perform in-depth analysis after capsule retrieval which will be a game changer for gut health diagnosis, and this advancement is also covered in this review. The expansion of smart capsules to robotic capsules for gut microbiota collection has opened new avenues for research with a great promise to revolutionise human health diagnosis, monitoring and intervention.
... En general, entre el 80-85 % de los pacientes experimentan alivio sintomático luego de ser intervenidos quirúrgicamente, que persiste por más de 10 años 6,7 . Sin embargo, esta intervención no es efectiva en todos los casos, y se ha descrito que hallazgos como la dilatación esofágica mayor a ocho cm o megaesófago, predicen la necesidad de intervenciones adicionales. ...
Introducción. La acalasia es un trastorno motor del esófago caracterizado por la ausencia de peristalsis y la alteración en la relajación del esfínter esofágico inferior. La cardiomiotomía laparoscópica de Heller más funduplicatura parcial es el tratamiento estándar. La mejoría sintomática ha sido bien documentada, pero no hay suficiente información objetiva respecto a los cambios fisiológicos y radiográficos luego del procedimiento. Métodos. Estudio de cohorte bidireccional de pacientes llevados a cardiomiotomía laparoscópica de Heller, entre los años 2018 y 2021, en el Hospital Universitario San Vicente Fundación de Medellín, Colombia. Se describen variables demográficas y clínicas. Se realizaron puntaje sintomático de Eckardt, manometría esofágica y radiografía de esófago en el pre y postoperatorio. Se hizo comparación de síntomas, presión basal del esfínter esofágico inferior, presión de relajación integrada y diámetro del esófago antes y después de la intervención. Resultados. Se incluyeron 24 pacientes. El 63 % fueron mujeres y la edad promedio fue de 44 años. Los valores promedio preoperatorios vs postoperatorios fueron: puntaje de Eckardt 10,6 vs 1,4 puntos (p<0,001), presión basal de 41,4 vs 18,1 mmHg (p=0,004) y presión de relajación integrada de 28,6 vs 12,5 mmHg (p=0,001). El diámetro del esófago no presentó cambios. No hubo correlación de síntomas con los cambios de presión del esfínter esofágico inferior. El tiempo de seguimiento fue de 20 meses. Conclusiones. La cardiomiotomía de Heller es un procedimiento altamente efectivo para el tratamiento definitivo de la acalasia, logrando una mejoría subjetiva y objetiva basada en síntomas y en parámetros de manometría, respectivamente.
... Retention of food in the lower esophagus can often present as a feeling of chest pressure or retrosternal chest pain [6,7]. Usually, the pain is not too strong, is not constant and is said to be like "fire in the chest" or heartburning [8]. The mechanism of the pain can be linked to irritation of the acid content, compression of the airway and surrounding tissue or spasm of the esophagus itself. ...
Three subtypes of achalasia have been defined using esophageal manometry. Several studies have reported that symptoms are experienced differently among men and women, regardless of subtype. All subtypes could have some impact on the appearance of respiratory symptoms and lung complications due to compression of the trachea or aspiration of undigested food. The aim of this research was to analyze the differences in respiratory symptoms and radiographic presentation of lung pathology depending on the diameter and achalasia types. One or more respiratory symptoms were reported in 48% of 114 patients, and all of them had two or more gastrointestinal symptoms. The symptom score (SS) is statistically significant for the prediction of subtype 1 (area under the curve = 0.318; p < 0.001, cut-off score of 6.5 had 95.2% sensitivity) and subtype 2 (area under the curve = 0.626; p = 0.020, cut-off score of 7.5 had 93.1% sensitivity). The most common type was subtype 2 (50.8%), and although only 14 patients had subtype 3, they had the largest esophageal diameter (mean 5.8 cm). The difference in esophageal diameter was significant between subtype 1 and 3 (p = 0.011), subtype 2 and subtype 3 (p = 0.011). Nine patients (6%) had mega-esophagus (four patients in type 1, three in type 2 and two in type 3). More than half of all patients (51.7%) had at least one parenchymal lung change on CT scan. Recurrent micro-aspirations led to changes in the structure of the airways and lung parenchyma such as ground glass (GGO) and nodular changes (12%) and fibrosis (14.5%), and they had higher esophageal diameters (p < 0.001). Patients with chronic lung CT changes had significantly higher esophageal diameter than with acute changes (p < 0.001). Awareness of the association of achalasia and lung disorders is important in early diagnosis and treatment. More than half (57.5%) of patients with achalasia had some clinical and/or structural pulmonary abnormalities. All three subtypes had similar respiratory symptoms, meaning they cannot be used to predict the subtype of achalasia; on the contrary, SS can predict the first two subtypes. A higher diameter of the esophagus is associated with chronic structural lung changes. Although unexpected, the pathological radiological findings and diameter were significantly different in subtype 3 patients, but those parameters cannot lead us to a specified subtype.
... Achalasia is a primary motility disorder of unknown etiology. [9] Although it is rare, it usually occurs between the ages of 20-50, regardless of gender. Indeed, in our study, 91% of our patients were in this age range. ...
Achalasia cardia, type of esophageal dynamic disorder, is a relatively rare primary motor esophageal disease characterized by the functional loss of plexus ganglion cells in the distal esophagus and lower esophageal sphincter. Loss of function of the distal and lower esophageal sphincter ganglion cells is the main cause of achalasia cardia, and is more likely to occur in the elderly. Histological changes in the esophageal mucosa are considered pathogenic; however, studies have found that inflammation and genetic changes at the molecular level may also cause achalasia cardia, resulting in dysphagia, reflux, aspiration, retrosternal pain, and weight loss. Currently, the treatment options for achalasia focus on reducing the resting pressure of the lower esophageal sphincter, helping to empty the esophagus and relieve symptoms. Treatment measures include botulinum toxin injection, inflatable dilation, stent insertion, and surgical myotomy (open or laparoscopic). Surgical procedures are often subject to controversy owing to concerns about safety and effectiveness, particularly in older patients. Herein, we review clinical epidemiological and experimental data to determine the prevalence, pathogenesis, clinical presentation, diagnostic criteria, and treatment options for achalasia to support its clinical management.
