Treatment of achalasia cardia of the esophagus. What is esophageal achalasia and how to beat it Achalasia treatment

Achalasia of the esophagus is a neuromuscular disorder of the motor activity of the esophagus (peristalsis) with impaired function of the lower sphincter, which leads to difficulty in passing food through the digestive tract.

Achalasia affects both men and women between the ages of 25 and 60. In Europe, this disease is diagnosed in 5-8 cases per 1 million people. World practice notes 4-6 cases per 1 million population. Esophageal achalasia is often referred to as cardiospasm or achalasia of the cardia.

Varieties of the disease

There are two main types of esophageal achalasia - the first type and the second.

The first type is characterized by the preservation of the walls and shape of the organ. The second type is distinguished by the absence of esophageal tone, its significant increase and curvature of the shape.

There are also 4 stages of the disease:

• initial - manifested by narrowing of the sphincter at the bottom of the esophagus, swallowing difficulties are rare, patients complain of burning, nausea;
• stable - manifested by a constant spasm of the sphincter at the bottom of the esophagus, the esophagus itself expands slightly, while swallowing food is difficult, patients are tormented by coughing and profuse salivation;
• cicatricial - manifested by cicatricial changes due to food jamming and sclerosis, the sphincter loses its elasticity and increases significantly in size;
• complications - manifested by the narrowing of the sphincter below, the appearance of inflammation, ulcers and tissue necrosis.

Achalasia of the cardia of the esophagus is a violation of the possibility of opening the cardia of the stomach. Cardia is a valve that protects the esophagus from accidental injection of gastric juice and food debris, i.e. it separates the esophagus from the stomach. If there is a disorder in the work of intestinal motility and a decrease in the tone of the esophagus, a disease manifests itself - achalasia of the cardia. It is characterized by a sharp and fairly rapid manifestation of all the symptoms of achalasia disease.

This type of achalasia affects people aged 40-50 years, there are also cases of the disease between the ages of 14 and 20 years.

Causes and factors of achalasia

The mechanism of manifestation of this disease is quite simple. The onset of the disease is accompanied by a disruption in the functioning of nerve cells responsible for normal peristalsis and impulses that are transmitted to the muscles of the esophagus (especially in its lower part).

To date, the causes have not been accurately studied, but the following factors that provoke the disease are distinguished:

• infectious - herpes simplex viruses, chickenpox, cytomegalovirus;
• hereditary;
• inadequate diet;
• lack of B vitamins;
• psychogenic - various psychological traumas, depressions, severe stresses.

Signs and symptoms of achalasia

The main signs of the disease include:

• difficulty swallowing is the main symptom;
• throwing food debris into the oral cavity - after stagnation of food, it is possible without an admixture of bile and juice;
• - manifests itself mainly after the reflux of gastric juice into the esophagus and is characterized by the separation of sputum in the form of foam;
• regurgitation of foam - from excessive salivation;
• retrosternal pain - a private sign of a pressing character;
• heartburn.

Diagnostics

To identify the disease, methods of esophageal manometry, plain radiography, and radiopaque esophagography are used. The latter diagnostic method allows to determine the disease at an early stage and is suitable for patients with complaints of swallowing difficulties.

Manometry makes it possible to determine the stage and distinguish achalasia from other diseases of the digestive tract.

Treatment

Treatment of esophageal achalasia is aimed at relief of manifestations and high-quality prevention of complications.

Treatment Methods

For the treatment of esophageal achalasia, there are three main methods of treatment - non-drug, medical and surgical.

Non-drug treatment is usually used in the early stages of the disease. This type of therapy also includes treatment with folk remedies. It is mainly aimed at normalizing the diet and fluid intake.

The drug method consists in taking certain drugs that contribute to the normalization of the nervous and digestive systems.

The surgical method is presented in three ways - cardiomyotomy, pneumatic cardiodilatation and partial fundoplication.

Medicines and preparations

In drug treatment, several groups of drugs are used:

• nitroglycerin - Nitroglycerin;
• calcium blockers - Isotropin, Cordaflex, Finotropin, Cordipin;
• nitrates - Kardiket;
• prokinetics -;
• sedatives - Persen.

All of them have a complex effect on the body and, in particular, on reducing pressure in the sphincter and esophagus.

Treatment with folk remedies

In parallel with drug treatment, traditional medicine recipes can also be used, but this type of treatment should be taken as an additional one for faster recovery of the body.

• Tinctures of Eleutherococcus, Schisandra, and Aralia, extracts of radiola rosea are used as general tonic.
• To relieve inflammation and during the period of prevention, decoctions of oregano herbs, marshmallow root, alder cones, quince seeds are used.
• Herbal preparations from oak bark, walnut leaves, cinquefoil root and St. John's wort are effective.
• Motherwort, peony tincture and valerian are used as sedative folk remedies.

Side effects

With untimely treatment or its absence, rapid progression of the disease is possible, which can lead to partial or complete disability.

Prevention of achalasia of the esophagus

As preventive measures can be called:

• moderate physical activity;
• giving up all bad habits (smoking, alcohol);
• walks in the open air;
• if necessary, visit a psychologist.

Why is the disease dangerous?

Among the complications, the development of the following diseases is distinguished:

• squamous cell carcinoma of the esophagus;
• depletion of the body;
• lung damage;
• pneumopercardia;
• veins of the esophagus;
• cervical neoplasms;
• exfoliation of the submucosal layer in the esophagus;
• bezoars of the esophagus;
• distal diverticulum;
• fistula of the esophagus;
• Barrett's esophagus;
• purulent pericarditis;
• stridor.

Diet, nutrition

In the treatment and prevention of achalasia cardia of the esophagus, it is important to follow the following recommendations:

• completely remove from the diet spicy, fatty and fried foods that irritate the esophagus;
• eat often and in small portions while drinking plenty of water with food;
• give up any energy drinks, coffee, carbonated drinks and large amounts of sugar and carbohydrates;
• eat only those foods that stimulate the stomach and are able to digest quickly.

Features in children

Achalasia in children is diagnosed mainly after 5 years. It is due to the inability to relax the muscles of the esophagus. It is difficult to define the disease, but it usually manifests itself in the form of regurgitation, night cough and difficulty swallowing food.

If left untreated, esophageal achalasia can lead to complications such as anemia, developmental delay, bronchitis, and pneumonia.

- this is the lack of relaxation or insufficient relaxation of the lower esophagus of neurogenic etiology. Accompanied by a disorder of the reflex opening of the cardiac opening during the act of swallowing and a violation of the ingress of food masses from the esophagus into the stomach. Achalasia cardia is manifested by dysphagia, regurgitation and pain in the epigastrium. The leading diagnostic methods are fluoroscopy of the esophagus, esophagoscopy, esophagomanometry. Conservative treatment consists in carrying out pneumocardiodilatation; surgical - in performing cardiomyotomy.

ICD-10

K22.0 Achalasia of the cardia

General information

Achalasia of the cardia in the medical literature is sometimes referred to by the terms megaesophagus, cardiospasm, idiopathic dilatation of the esophagus. Achalasia of the cardia, according to various sources, in practical gastroenterology ranges from 3 to 20% of all diseases of the esophagus. Among the causes of esophageal obstruction, cardiospasm is in third place after esophageal cancer and post-burn cicatricial strictures.

Pathology with the same frequency affects women and men, more often develops at the age of 20-40 years. With achalasia of the cardia, as a result of neuromuscular disorders, the peristalsis and tone of the esophagus decrease, there is no reflex relaxation of the esophageal sphincter when swallowing, which makes it difficult to evacuate food from the esophagus to the stomach.

Causes

Many etiological theories have been put forward for the origin of achalasia cardia, which associate the development of pathology with a congenital defect in the nerve plexuses of the esophagus, secondary damage to nerve fibers in tuberculous bronchoadenitis, infectious or viral diseases; vitamin B deficiency, etc. The concept of violations of the central regulation of the functions of the esophagus is widespread, considering achalasia of the cardia as a result of neuropsychic injuries leading to a disorder of cortical neurodynamics, innervation of the esophagus, and discoordination in the work of the cardiac sphincter. However, the factors contributing to the development of the disease remain unclear.

The leading role in the pathogenesis of achalasia cardia is assigned to the defeat of the parts of the parasympathetic nervous system that regulates the motility of the esophagus and stomach (in particular, the Auerbach plexus). Secondary (symptomatic) achalasia of the cardia can be caused by infiltration of the plexus by a malignant tumor (adenocarcinoma of the stomach, hepatocellular cancer, lymphogranulomatosis, lung cancer, etc.). In some cases, the Auerbach's plexus can be affected in myasthenia gravis, hypothyroidism, poliomyositis, and systemic lupus erythematosus.

Pathogenesis

The actual denervation of the upper gastrointestinal tract causes a decrease in peristalsis and tone of the esophagus, the impossibility of physiological relaxation of the cardiac opening during the act of swallowing, and muscle atony. With such disorders, food enters the stomach only due to the mechanical opening of the cardiac opening, which occurs under the hydrostatic pressure of liquid food masses accumulated in the esophagus. Prolonged stagnation of the food bolus leads to the expansion of the esophagus - megaesophagus.

Morphological changes in the wall of the esophagus depend on the duration of the existence of achalasia cardia. At the stage of clinical manifestations, there is a narrowing of the cardia and expansion of the lumen of the esophagus, its elongation and S-shaped deformation, coarsening of the mucous membrane and smoothing of the folding of the esophagus. Microscopic changes in achalasia of the cardia are represented by hypertrophy of smooth muscle fibers, proliferation of connective tissue in the esophageal wall, pronounced changes in the intermuscular nerve plexuses.

Classification

According to the severity of esophageal dysfunction, the stages of compensation, decompensation and sharp decompensation of achalasia of the cardia are distinguished. Among the many proposed classification options, the following staging option is of greatest clinical interest:

• I stage. It is characterized by intermittent spasm of the cardiac region. Macroscopic changes (stenosis of the cardia and suprastenotic expansion of the lumen of the esophagus) are not observed.
• II stage. Spasm of the cardia is stable, there is a slight expansion of the esophagus.
• III stage. A cicatricial deformity of the muscular layer of the cardia and a sharp suprastenotic expansion of the esophagus are revealed.
• IV stage. It proceeds with a pronounced stenosis of the cardiac section and a significant dilatation of the esophagus. It is characterized by the phenomena of esophagitis with ulceration and necrosis of the mucosa, periesophagitis, fibrous mediastinitis.

In accordance with radiological signs, two types of achalasia of the cardia are distinguished. The first type of pathology is characterized by moderate narrowing of the distal segment of the esophagus, simultaneous hypertrophy and dystrophy of its circular muscles. Dilatation of the esophagus is expressed moderately, the site of expansion has a cylindrical or oval shape. Type 1 achalasia cardia occurs in 59.2% of patients.

The second type of achalasia cardia is said to be with a significant narrowing of the distal esophagus, atrophy of its muscular membrane and partial replacement of muscle fibers with connective tissue. There is a pronounced (up to 16-18 cm) expansion of the suprastenotic esophagus and its S-shaped deformation. Achalasia of the cardia of the first type can eventually progress to the second type. Knowing the type of achalasia cardia allows gastroenterologists to anticipate possible difficulties in conducting pneumocardiodilatation.

Symptoms of achalasia cardia

Clinical manifestations of the pathology are dysphagia, regurgitation and retrosternal pain. Dysphagia is characterized by difficulty swallowing food. In some cases, a violation of the act of swallowing develops simultaneously and proceeds stably; usually dysphagia is preceded by influenza or another viral disease, stress. In some patients, dysphagia is initially episodic (for example, with hurried eating), then becomes more regular, making it difficult to pass both solid and liquid food.

Dysphagia in achalasia of the cardia can be selective and occur when only a certain type of food is consumed. Adapting to the violation of swallowing, patients can independently find ways to regulate the passage of food masses - hold their breath, swallow air, drink food with water, etc. Sometimes, with achalasia of the cardia, paradoxical dysphagia develops, in which the passage of liquid food is more difficult than solid.

Regurgitation in achalasia of the cardia develops as a result of the reverse reflux of food masses into the oral cavity during contraction of the muscles of the esophagus. The severity of regurgitation may be in the nature of a small regurgitation or esophageal vomiting, when profuse regurgitation develops "full mouth". Regurgitation can be intermittent (for example, during eating, simultaneously with dysphagia), occur immediately after a meal, or 2-3 hours after a meal. Less often, with achalasia of the cardia, food reflux can occur during sleep (the so-called nocturnal regurgitation): in this case, food often enters the respiratory tract, which is accompanied by a "night cough". A slight regurgitation is typical for stages I - II of achalasia of the cardia, esophageal vomiting - for stages III - IV, when the esophagus is overfilled and overstretched.

Pain in achalasia cardia can disturb on an empty stomach or in the process of eating when swallowing. Pain sensations are localized behind the sternum, often radiating to the jaw, neck, between the shoulder blades. If at stages I - II of achalasia of the cardia pain is caused by spasm of the muscles, then at stages III - IV - by developing esophagitis. For achalasia cardia, periodic paroxysmal pains are typical - esophagodynic crises, which can develop against the background of excitement, physical activity, at night and last from several minutes to one hour. A painful attack sometimes goes away on its own after vomiting or the passage of food masses into the stomach; in other cases, it is stopped with the help of antispasmodics.

Complications

Violation of the passage of food and constant regurgitation with achalasia of the cardia lead to weight loss, disability, and a decrease in social activity. Against the background of characteristic symptoms, patients develop neurosis-like and affective states. Often, patients are treated for a long time and unsuccessfully by a neurologist for these disorders. Meanwhile, neurogenic disorders almost always regress after the treatment of achalasia of the cardia.

Diagnostics

In addition to typical complaints and physical examination data, the results of instrumental studies are extremely important in the diagnosis of achalasia of the cardia. Examination of a patient with suspected achalasia of the cardia begins with a plain chest x-ray. If a shadow of the dilated esophagus with a liquid level is detected on the radiograph, an x-ray of the esophagus is indicated with a preliminary intake of a barium suspension. The X-ray picture in achalasia of the cardia is characterized by a narrowing of the final section of the esophagus and an expansion of the overlying area, an S-shaped organ.

Drug therapy for achalasia cardia plays an auxiliary role and is aimed at prolonging remission. For this purpose, it is advisable to prescribe antidopaminergic drugs (metoclopramide), antispasmodics, small tranquilizers, calcium antagonists, nitrates. In recent years, botulinum toxin administration has been used to treat achalasia cardia. Important points for achalasia of the cardia are the observance of a sparing diet and diet, the normalization of the emotional background, and the exclusion of overstrain.

Forecast and prevention

The course of achalasia cardia is slowly progressive. Untimely treatment of the pathology is fraught with bleeding, perforation of the esophageal wall, the development of mediastinitis, and general exhaustion. Achalasia cardia increases the risk of developing esophageal cancer. After pneumocardiodilation, a relapse after 6-12 months is not excluded. The best prognostic results are associated with the absence of irreversible changes in esophageal motility and early surgical treatment. Patients with achalasia of the cardia are shown dispensary observation of a gastroenterologist with the implementation of the necessary diagnostic procedures.

Achalasia of the esophagus is a neuromuscular pathology of the organ associated with impaired peristalsis and muscle tone. In the presence of this disease, the opening of the cardiac opening does not occur when food is swallowed, because of which it does not enter the stomach.

The main signs of esophageal achalasia are: dysphagia and regurgitation, heaviness and pain in the epigastric region. To detect the disease, esophagoscopy, x-ray examination of the upper digestive system, esophagomanometry are used. This pathology can be treated with both conservative and surgical methods.

What causes esophageal achalasia?

Cardiospasm occurs in 3% of cases of diseases of the esophagus. Among the factors that violate the patency of the body, achalasia is in 3rd place after malignant tumors and tissue scarring. The disease is found with equal frequency in men, women and children. The mechanism of development of the pathological process is based on a violation of peristalsis and muscle tone associated with nervous disorders. When swallowing, the esophagus does not relax, which prevents food from moving into the stomach.

There are many assumptions regarding the causes of chalasia and achalasia of the esophagus. Among the provoking factors are:

• congenital anomalies of the nerve endings of the digestive tract;
• secondary tissue damage in tuberculous bronchoadenitis, bacterial and viral infections;
• deficiency of vitamins and nutrients.

Since the work of all organs and systems is under the control of the brain, achalasia of the cardia can develop with neuropsychiatric disorders, traumatic brain injuries and inflammatory processes that contribute to the termination of signal transmission to the nerve endings of the esophagus. Other causes of the disease remain unexplored.

The main role in the development of the pathological process is played by the defeat of the part of the parasympathetic nervous system that regulates the work of the gastrointestinal tract. Secondary achalasia of the cardia can occur when the nerve endings are irritated by a malignant tumor against the background of cancer of the lungs, stomach, and lymphatic system. In some cases, the nerve plexus is affected by hypothyroidism, myositis, lupus erythematosus.

The lack of conductivity of the nerve endings of the digestive system contributes to a decrease in contractility and muscle tone. Due to atony, the cardiac opening cannot open when food enters the esophagus. The contents enter the stomach only under the influence of the pressure created by it. Prolonged stagnation of fluid contributes to the expansion of the esophagus.

The severity of pathological changes in the tissues of the organ depends on the stage of the disease. When a detailed clinical picture appears, narrowing of the cardiac opening, expansion of the lower parts of the esophagus, their stretching and deformation are detected. The mucous membrane thickens and loses physiological folds. Histological signs of achalasia cardia are the growth of smooth muscle fibers, hypertrophy of connective tissues, a significant change in the state of the nerve plexuses.

Disease classification

Achalasia of the cardia occurs in 4 stages, each of which has its own clinical and diagnostic signs. On 1 there is an intermittent spasm of the cardia. Histological and external changes in the tissues of the esophagus are not observed. At the next stage, the pathological narrowing of the hole becomes permanent. Mild dilatation of the esophagus is noted.

Achalasia of the 3rd degree is characterized by cicatricial degeneration of the mucous membranes, a significant stretching of the walls of the organ. At stage 4, there is a pronounced stenosis of the cardia and expansion of the esophagus. Manifested in the form of ulcerative esophagitis and the appearance of areas of necrosis. Some doctors also distinguish stage 0 of the disease - dyschalasia, characterized by the presence of transient dysfunctions of the cardia.

On the basis of radiological signs, achalasia of the cardia is divided into 2 forms. The first is characterized by moderate stenosis of the lower esophagus with simultaneous growth of circular muscles. Stretching of the organ has an average degree of severity, the expanded area is rounded. This type of disease is diagnosed in more than half of patients. The second type of achalasia is characterized by a significant narrowing of the cardiac opening, atrophy of the muscle tissues of the esophagus and their partial replacement with connective tissue fibers. The upper parts of the organ greatly expand, it lengthens and curves.

Type 1 achalasia cardia can eventually turn into type 2 cardiospasm. Determining the form of the disease allows doctors to avoid complications during cardiodilatation. According to the degree of dysfunction of the esophagus, achalasia is divided into compensated, decompensated and complicated.

Clinical picture of the disease

The main sign of cardiospasm is dysphagia, which is accompanied by food regurgitation and the appearance of pain in the middle part of the chest. Swallowing problems can develop gradually or occur spontaneously. Their appearance is often preceded by a viral infection, psycho-emotional overload, candidiasis.

In some cases, dysphagia occurs spontaneously, for example, with a hasty meal. Over time, it can become permanent, which will make it almost impossible to eat both dense and semi-liquid dishes. Dysphagia can be selective, with problems occurring when certain types of food are swallowed.

Adapting to these symptoms, patients begin to look for ways to regulate the progress of the food bolus - swallow air, hold their breath, drink water. In paradoxical dysphagia, it is more difficult to swallow liquid than solid food. Regurgitation is the reflux of masses in the esophagus into the oral cavity. This is facilitated by a sharp contraction of the muscles. Similar symptoms can have varying degrees of severity - from belching to an attack of vomiting. Regurgitation can occur during a meal or some time after it is completed. Throwing of masses can occur at night, while their penetration into the respiratory tract often occurs.

Symptoms of esophageal achalasia can appear both on an empty stomach and after eating. The pains are localized in the middle part of the sternum, they can radiate to the jaw, neck, back. If at stage 1 they are associated with muscle spasm, then in the future their occurrence is facilitated by long-term esophagitis. Pain with achalasia of the esophagus has a paroxysmal character.

The crisis can happen against the background of stress, high physical exertion, night sleep. It lasts from several minutes to an hour. An attack of vomiting helps to temporarily alleviate the patient's condition. The pain may also disappear when food is moved into the stomach. In other cases, it is removed with the help of antispasmodics.

Problems with swallowing and constant bouts of vomiting lead to exhaustion of the body, reduced performance and physical activity. The main symptoms of the disease may be accompanied by neurotic and affective disorders. Often, the patient visits a neurologist for a long time, but the treatment prescribed by him does not bring any result. Neurological disorders disappear after the elimination of cardiospasm.

Diagnosis of achalasia cardia

The examination of the patient begins with an examination and analysis of his symptoms. Instrumental diagnostic procedures are especially important. Plain radiography revealed an increase in the shadow of the esophagus. In this case, an additional examination is carried out with the introduction of a contrast agent. The main diagnostic signs of esophageal achalasia are the narrowing of the distal organ with the expansion of the area located above, S-shaped deformation.

With the help of esophagoscopy, the form and stage of cardiospasm, the severity of pathological changes in the tissues of the organ are determined. If there are suspicions of malignant neoplasms, an endoscopic biopsy is performed with a morphological analysis of the material.

To assess the degree of violation of esophageal motility and sphincter tone, esophagomanometry is used, which measures pressure in the esophageal cavity. A characteristic sign of achalasia is the absence of a cardiac reflex when swallowing. Informative are tests with carbachol. With the introduction of this drug, chaotic contractions of smooth muscles are noted, which indicates denervation of the organ. When making a final diagnosis, it is necessary to exclude benign neoplasms, diverticulosis, cancer of the stomach and esophagus.

Ways to eliminate the disease

Treatment of esophageal achalasia is aimed at relieving cardiospasm. For this purpose, both conservative and surgical methods can be used. The most effective method of non-surgical therapy is balloon dilatation of the cardiac sphincter. The procedure is carried out in several stages, devices of various sizes are used, the pressure increases gradually.

Such treatment allows to eliminate the stenosis of the cardiac opening and restore the patency of the esophagus. Complications of this procedure are cracks and ruptures of the esophagus, the occurrence of reflux - esophagitis, scarring of tissues.

Surgical treatment helps to permanently get rid of esophageal achalasia - dissection of the cardia followed by fundoplication. The operation is performed in the presence of a hernia of the esophagus, diverticulosis, cancer of the upper sections of the stomach. Selective vagotomy is prescribed for duodenal ulcer, accompanied by cardiac insufficiency. In the presence of severe forms of reflux - esophagitis, the upper sections of the stomach and the lower part of the esophagus are removed. The surgery is completed with pyloroplasty.

Drug treatment plays a secondary role, it is aimed at improving the general condition of the digestive system. With achalizia of the esophagus, antispasmodics, calcium antagonists, tranquilizers, nitrates are most often used. Botox injections help to eliminate the main symptoms of the disease - dysphagia and regurgitation.

Treatment of achalasia should be supplemented by a special diet and the normalization of the state of the nervous system. The disease is characterized by slow development. If untreated, internal bleeding, esophageal ulcer, cachexia may develop. The presence of cardiospasm significantly increases the risk of malignant neoplasms. After performing balloon dilatation, in most cases, the symptoms of the disease reappear.

Chalasia and achalasia of the esophagus are serious disorders in the functioning of this internal organ. Such diseases, despite the same localization, have a different course and causes. Let's consider them in more detail.

Achalasia is a neurogenic disease of the lower sphincter in the human esophagus, which contributes to the dysfunction of this muscular valve.

In most cases, adults suffer from achalasia, but there are cases when this disease is detected in young children and even in newborn babies.

By its nature, this pathology is not very serious, but its danger lies in the fact that achalasia can cause severe complications in the patient's condition. Most often, these are the development of cancer, chronic pain, and pericarditis.

Causes

The following factors can cause the development of achalasia:

• Long flowing in the area of ​​the gastrointestinal tract.
• Untreated oncological pathologies in the esophagus.
• The hereditary predisposition of a person to this disease.
• Strong psycho-emotional overstrain and stress.

Important! An unstable psycho-emotional state can also cause other serious disorders in the gastrointestinal tract, cardiovascular and even endocrine systems.

• Burn of the esophagus.
• Mechanical damage to the esophagus (which may be accompanied).
• Leading an unhealthy lifestyle of a pregnant woman can cause this disease in a baby.
• Living in a polluted ecological environment.

Important! In newborn babies, achalasia, unfortunately, is very often observed along with diseases such as Down's syndrome or Alport's disease.

Degrees and symptoms

There are four separate degrees of this disease:

1. The first degree is accompanied by a loss of elasticity of the esophageal sphincter. In this case, the person will not feel pain, but it may be unpleasant for him to swallow solid food.
2. The second degree of leakage contributes to the onset of deformation of the sphincter in the esophagus. In this condition, the patient may experience the first spasms and pain in the chest.
3. The third degree is a condition in which a person has scarring of the sphincter. In this case, the patient's esophagus expands very much, from which the person feels acute pain.
4. The fourth degree is considered the most dangerous, since it is constantly exposed to gastric juice, in this state the inflammatory process gradually develops. In this case, the patient may develop purulent discharge.

The general course of the disease is accompanied by the following symptoms:

1. Dysphagia is the most common symptom of this disease. It is expressed in soreness and difficulty in swallowing food. During this process, the patient may feel a dull pain in the chest. It is also characteristic that dysphagia will only worsen in the absence of timely treatment.
2. The pain syndrome can be acute, stabbing, pressing or cutting. Sometimes there is also paroxysmal pain. This phenomenon occurs due to a sharp contraction of the muscles of the esophagus. Pain worsens with anxiety or overwork.
3. Frequent regurgitation can be quite painful and sudden. Also, sometimes regurgitation can be accompanied by heartburn and vomiting.
4. Often there is a cough, especially at night.
5. The patient can lose weight dramatically, the face will have all the signs of exhaustion of the body - weakness, loss of appetite, pallor, disability, anemia.
6. Decreased immunity, due to which the patient will be more susceptible to various respiratory and infectious diseases.
7. The appearance of bad breath.
8. When diagnosing ultrasound, it is possible to observe the expansion of the esophagus and the reduction of the stomach.
9. Frequent nausea and feeling of heaviness in the esophagus.

Methods of diagnosis and treatment

To identify achalasia, you should be examined by a doctor, take blood tests, do an ultrasound of the esophagus and endoscopy. Doctors also recommend manometry.

After identifying the disease, individual therapy is prescribed (it depends on the degree of neglect of the pathology).

Traditional treatment is aimed at restoring the patency of the sphincter and eliminating pain. It provides for this:

1. Prescribing drugs that reduce pressure in the esophagus. The best of these are Cerucal, Nitrosorbit.
2. Appointment of sedatives (Novo-passit, valerian, motherwort extract).
3. Compliance with dietary nutrition.

If drug therapy does not help, the patient is prescribed surgical treatment.

Prevention

To reduce the risk of developing achalasia, the following recommendations should be followed:

1. Timely treat any diseases of the digestive tract and prevent their transition to a chronic form.
2. When the first unpleasant sensations appear when swallowing, immediately consult a doctor and do not self-medicate.
3. Stick to a healthy diet and nutrition.
4. Quit smoking and drinking alcohol.
5. Avoid overeating.
6. Refuse dry food.

What is chalazia

Chalazia is the opposite of achalasia, a disease of the gastric sphincter, which develops due to the immaturity of this section.

Moreover, the following reasons can provoke the appearance of this pathology:

1. Overweight person.
2. Insufficiently active (sedentary) lifestyle.
3. Binge eating.
4. Frequent eating at night, when all body functions are not working so actively.

Important! Night meals are very harmful, as they overload the stomach, and also contribute to obesity.

1. Irregular eating schedule.
2. Dry food.
3. Drinking alcohol.
4. Chronic diseases of the gastrointestinal tract.

Symptoms and manifestations of chalazia

Chalazia has the following features of its course:

1. The patient often begins to worry about heartburn. In this case, the release of gastric juice into the esophagus will not only cause an unpleasant burning sensation, but also soreness. Moreover, it is characteristic that such heartburn will provoke pain not only during meals and on an empty stomach, but also after meals.
2. Nausea and vomiting are the second most common symptom.
3. Bad burp.
4. Soreness after eating.

Features of treatment

After establishing the disease, a person is assigned an individual course of therapy. In many ways, it will depend on the neglect of the pathology, as well as the reasons that provoked its occurrence.

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