Hiatus Hernia :: Achalasia
Achalasia, is a disorder of the oesophagus where the lower oesophageal
doesn't relax properly with swallowing. The oesophagus is less able to move
toward the stomach and the valve from the oesophagus to the stomach does not
relax as much as it needs to during swallowing.
Under normal circumstances, when you swallow, food is passed down the
by waves of muscle contractions and into the stomach.
Lower oesophageal sphincter
A 'valve', which doctors call a sphincter, controls the entry of food from the
of the oesophagus into the stomach. This particular sphincter is known as the
oesophageal sphincter. It is a band of muscle that opens to allow the food to
from the oesophagus down into your stomach and then closes again to prevent
acidic stomach contents from coming back up.
In achalasia the lower oesophageal sphincter doesn't relax properly with
which means that food is not pushed down into the stomach. Instead, it becomes
lodged in the oesophagus. This happens because achalasia affects the nerves
control the sphincter muscles.
Another feature of achalasia is that the normal rhythmic contractions of the
which propel food down it towards the stomach (doctors call this peristalsis),
Doctors think that this may be due to a malfunction of the nerves that encase
Achalasia can happen at any age, but begins most often between 20 and 40
of age. It can start almost unnoticed, gradually advancing over a long period.
- Tearing (perforation) of the oesophagus
- Regurgitation of acid or food from the stomach into the oesophagus
- Aspiration of food contents into the lung that can cause pneumonia
The approach to treatment is to reduce the pressure at the lower
sphincter. This may be achieved by manipulating the lower oesophagus sphincter
with special instruments.
Medications can also be used to lower the pressure at the lower oesophagus
Surgery to decrease the pressure in the lower sphincter (called an
may be indicated if other interventions fail.
|© Mr. Ian Michell- Laparoscopic General Surgeon