L'achalasie (méga-œsophage idiopathique)

A- Knowing the definition of achalasia:

The achalasia, etymologically failure to open the sphincter, is a primary esophageal motor disorder defined by an absence of peristalsis of the body of the esophagus and a relaxation of the lower esophageal sphincter missing or incomplete when swallowing.

B- Know the clinical and para-clinical arguments in favor of achalasia:

Early in the disease, the usual sign developer is dysphagia.

It may be very moderate, sometimes paradoxical electively affecting liquids.

Its main character is to be capricious: it occurs intermittently and unexpectedly or after an emotion and yields during inspiratory maneuver or position changes.

The achalasia (idiopathic mega-esophagus)
The achalasia (idiopathic mega-esophagus)

Rarely, the disease is revealed by retro-sternal pain constrictive, but not angina-related stress.

Paradoxically, this novice stage of the disease, upper gastrointestinal endoscopy is normal

At a more advanced stage, dysphagia loses its evocative character of a motor disorder. Regurgitations sometimes occur at night and are causing respiratory complications. It can lead to malnutrition.

C- know the main gauge abnormalities of achalasia:

In achalasia, various motor disturbances varying characteristics can be highlighted in manometry.

There is frequently hypertonia WIS and an absence or a relaxation of the sphincter defect, but these criteria may miss the initial stage.

The mandatory requirement of the diagnosis is the absence of peristalsis in the body of the esophagus.

Non propagated contractions are possible and even very important in vigorous achalasia.

D- Know the main differential diagnosis of achalasia:

Endoscopy should always be performed first-line to rule out a neoplastic disease, including cardia. An invasive tumor of the cardia can be the cause of motor disturbances very similar to those of achalasia (achalasia pseudo-neoplastic).

E- Schematic description of other motor disorders of the esophagus:

Apart from achalasia, esophageal motor disorders (recorded by manometry) considered primitive disease include diffuse esophageal spasm and nutcracker esophagus.

In sickness diffuse esophageal spasm, over 10% of waves recorded at the body of the esophagus are abnormal, not spread, and further répétitiveset alternate with normal peristalsis.

The nutcracker esophagus involves abnormal peristaltic waves, prolonged and high amplitude predominant in the distal portion of the esophagus.

During these two conditions, the operation of the WIS is normal.

Esophageal disorders called secondary engines can be observed in tissue diseases (scleroderma), diabetes, amyloidosis and many diseases of the central or peripheral nervous system.

It is also in this group of movement disorders that secondary achalasia are located including those due to neoplastic infiltration or a parasite Trypanosoma cruzi (Chagas disease).

F- Knowing the principles of treatment of achalasia:

The treatment aims to cut the SIO (surgical myotomy extramucosal) to distend the (pneumatic dilation), or improve the relaxation of the sphincter (nitrates sublingual, intra-sphincter infiltration of botulinum toxin) to allow emptying of the esophagus without causing GERD.

Pneumatic dilatation performed endoscopic and surgical treatment are the main methods.

Their effectiveness is comparable, considered excellent or good in over 3/4 of cases.

Their complications are rare, respectively perforation of the esophagus and reflux esophagitis.

Their mortality is almost zero.