References:
- Lecturer (Pascua)
The absence or ineffectiveness of peristalsis of the esophagus. This is primarily caused by the failure of the esophageal sphincter to relax in response to swallowing. This results in the accumulation of bolus in the esophagus during feeding.
- Risk Factors: >40 years old
- Signs and Symptoms: dysphagia, sensation of food sticking onto the lower esophagus, and spontaneous/intentional regurgitation.
- The patient often reports non-cardiac chest pain.
- A late sign may include pyrosis as the sphincter loosens from overfilling.
- Complications:
- Aspiration from backflow of food with regurgitation.
- Perforation from tearing of the esophagus, which may result in peritonitis
- Diagnostic Evaluation:
- X-ray studies, Barium swallow, CT scan: Check for allergies to iodine, shellfish, shrimps, etc.
- Endoscopy for visualization
- Manometry: measurement of the electrical activity of the esophageal musculature.
- Management:
- Diet: eat and drink slowly. Fluid intake is encouraged during meals to aid the food in being moved.
- Pharmacology:
- Oral calcium channel blockers and nitrates for smooth muscle relaxation.
- Botulinum injection (botox) that relaxes the contracted sphincter.
- Surgery:
- Esophagomyotomy or Endoscopic Myotomy: cutting/severing of contracted esophageal muscle fibers.
- Pneumatic Dilation: the use of air to dilate the sphincter.