Pneumatic dilation typically involves inserting a balloon into your esophagus and inflating it. This stretches out the sphincter and helps your esophagus function better. However, sometimes dilation tears the sphincter.
Balloon dilation is the first option. This option involves dilating the sphincter mechanically by inflating a large balloon inside it. This procedure helps over 85% of the time, but repeated dilations may be needed. The esophagus ruptures during the dilation procedure in very few people.
Eighty percent of patients with GERD also have a hiatal hernia, and during the fundoplication procedure, the hernial sac may also be surgically fixed. The procedure can be done with laparotomy, thoracotomy, or laparoscopy. Esophageal CancerEsophageal cancer is a disease in which malignant cells form in the esophagus. Risk factors of cancer of the esophagus include smoking, heavy alcohol use, Barrett’s esophagus, being male and being over age 60. Severe weight loss, vomiting, hoarseness, coughing up blood, painful swallowing, and pain in the throat or back are symptoms.
Dilation and esophagomyotomy to treat achalasia
The tissue sample is examined under a microscope for signs of inflammation, esophageal ulcers caused by undigested food, or cancer. If the esophagus looks very dilated, or if it appears that the muscles are not coordinated well, you may have achalasia. Your doctor and radiologist often recommend an esophageal high-resolution manometry to confirm the diagnosis.
The direct surgical approach has merit not only in treatment of the patients with achalasia intractable to conservative measures but also as an alternative to repeated bougienage. Good to excellent results were obtained in 78 per cent of the patients who underwent cardiomyotomy; various types of bougienage yielded good to excellent results in 45 per cent. When extensive dilatation, redundancy, and kinking of the esophagus have developed, careful, unhurried, and deliberate cardiomyotomy accomplished under direct vision and with absolute control of the length, breadth, and extent of the myotomy is less hazardous. In this series, there was no mortality and the incidence of postoperative esophagitis was low. The number of esophageal perforations (three patients; 5.5 per cent) from forceful bougienage, the total lack of mortality, and the gratifying results have led us in recent years to use cardiomyotomy frequently as the primary treatment for achalasia.
What causes esophageal spasm?
Infection with Trypanosoma cruzi can very closely mimic the picture of primary achalasia. Also, viral infections like measles and varicella zoster were suspected to be responsible for the neuronal changes, which has not been adequately confirmed.4 Achalasia patients were also found to have higher prevalence of circulating antimyenteric autoantibodies, which may support an autoimmune etiology.5 As a familial type of achalasia is also known, it was suggested that achalasia might be an inherited disease. Currently, it is thought that genetic predisposition in such individuals probably increases their susceptibility to achalasia after exposure to the same environmental factors that may play a role in the pathogenesis.6 Our hypothesis is that one possible initial insult that leads to the development of achalasia might be GERD. Severe esophagitis can damage the ganglion cells, and, later, an autoimmune reaction may develop, maintaining a chronic inflammation in the myenteric plexus of the esophagus. The theory that GERD could be an etiological factor in the development of achalasia was first proposed by Smart et al7 in 1986, who described five patients presenting with reflux and subsequently developing achalasia over the years.
If your child has difficulty swallowing or other symptoms of achalasia, especially if the symptoms have been present for several months and seem to be getting worse, talk to your child’s pediatrician. Achalasia is a rare disease in children, but once a diagnosis is made, surgical treatment is usually quite effective. Operative perforations occur in 1% to 5% in most series; however, the great majority are repaired with little or no morbidity or deleterious effects on successful relief of dysphagia. This is in comparison to dilation, where esophageal rupture has significant potential morbidity and mortality. Pneumothorax, bleeding, intraabdominal abscess, and wound infection can occur in approximately 3% of cases.
Heller first described the surgical destruction of the gastroesophageal sphincter, as therapy for achalasia, in 1913. His original technique used 2 parallel myotomies that extended for at least 8 cm on the distal esophagus and proximal stomach. The conversion to a single anterior myotomy was first proposed by De Brune Groenveldt in 1918. During the 1950s, the thoracic approach to esophagomyotomy was perfected, and in parts of the world, became the preferred technique.
Bansal R, Nostrant TT, Scheiman JM, Koshy S, Barnett JL, Elta GH, Chey WD. Intrasphincteric botulinum toxin versus pneumatic balloon dilation for treatment of primary achalasia. Mikaeli J, Fazel A, Montazeri G, Yaghoobi M, Malekzadeh R. Randomized controlled trial comparing botulinum toxin injection to pneumatic dilatation for the treatment of achalasia. Coccia G, Bortolotti M, Michetti P, Dodero M. Prospective clinical and manometric study comparing pneumatic dilatation and sublingual nifedipine in the treatment of oesophageal achalasia. Laws HL, Clements RH, Swillie CM. A randomized, prospective comparison of the Nissen fundoplication versus the Toupet fundoplication for gastroesophageal reflux disease.
Symptoms of achalasia
Karger AG, Basel. â€¢ A patient with dysphagia and chest pain was shown by manometry to have high-amplitude peristaltic esophageal contractions (nutcracker esophagus).
There are primary idiopathic motor disorders that include achalasia, diffuse esophageal spasm, nutcracker esophagus, hypertensive LES and nonspecific esophageal motility disorders. Esophageal spasm means that contractions of the esophagus are irregular, uncoordinated, and sometimes powerful. This condition may be called diffuse esophageal spasm, or DES. These spasms can prevent food from reaching the stomach. When this happens, the food gets stuck in the esophagus.