Sandbox: achalasia: Difference between revisions

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==DD==
==DD==


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!Manifestations
!Manifestations
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!Diagnostic tools
!Diagnostic tools
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|Achalasia
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* Dyspnea<ref>{{cite book | last = Ferri | first = Fred | title = Ferri's clinical advisor 2015 : 5 books in 1 | publisher = Elsevier/Mosby | location = Philadelphia, PA | year = 2015 | isbn = 978-0323083751 }}</ref>
*[[Dysphagia]] for solids and liquids is the most common feature, being seen in 91 % and 85% of patients respectively<ref name="pmid23871090">{{cite journal| author=Boeckxstaens GE, Zaninotto G, Richter JE| title=Achalasia. | journal=Lancet | year= 2013 | volume=  | issue=  | pages=  | pmid=23871090 | doi=10.1016/S0140-6736(13)60651-0 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23871090  }}</ref>
*[[Regurgitation]] of undigested food occurs in 76-91% of patients<ref name="pmid23871090">{{cite journal| author=Boeckxstaens GE, Zaninotto G, Richter JE| title=Achalasia. | journal=Lancet | year= 2013 | volume=  | issue=  | pages=  | pmid=23871090 | doi=10.1016/S0140-6736(13)60651-0 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23871090  }} </ref>
*[[Cough]] mainly when lying down in 30%<ref name="pmid23871090">{{cite journal| author=Boeckxstaens GE, Zaninotto G, Richter JE| title=Achalasia. | journal=Lancet | year= 2013 | volume=  | issue=  | pages=  | pmid=23871090 | doi=10.1016/S0140-6736(13)60651-0 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23871090  }} </ref>
|video trial
<div style="width:350px">{{#ev:youtube|5ucSlgqGAno}}</div>
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* Esophagogastroduodenoscopy findings include a dilated esophagus with residual food fragments, normal mucosa and occasionally [[candidiasis]] (due to the prolonged stasis).
* Barium swallow shows the characteristic bird's beak appearance.
[[Image:Acha.jpg|center|300px|thumb|Barium swallow showing bird's beak appearance - By Farnoosh Farrokhi, Michael F. Vaezi. - Idiopathic (primary) achalasia. Orphanet Journal of Rare Diseases 2007, 2:38(http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2040141), CC BY 2.0, https://commons.wikimedia.org/w/index.php?curid=2950922]]
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|GERD
|GERD
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* Cough and hoarseness of voice.
* Cough and hoarseness of voice.
* May present with complications such as strictures and dysphagia.
* May present with complications such as strictures and dysphagia.
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* Upper GI endoscopy shows the complications such as esophagitis and barret esophagus.
* Upper GI endoscopy shows the complications such as esophagitis and barret esophagus.
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*[[Pain and nociception|Pain]], often of a burning nature, may be severe and worsened by swallowing, and can be spasmodic in character
*[[Pain and nociception|Pain]], often of a burning nature, may be severe and worsened by swallowing, and can be spasmodic in character
*[[Nausea]] and [[vomiting]]
*[[Nausea]] and [[vomiting]]
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* Upper GI endoscopy and esophageal biopsy the gold standard for the diagnosis of esophageal
* Upper GI endoscopy and esophageal biopsy the gold standard for the diagnosis of esophageal
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*Retrosternal chest pain that presents with or without food intake.
*Retrosternal chest pain that presents with or without food intake.
*The condition is not progressive and not causing complications.
*The condition is not progressive and not causing complications.
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* Barium swallow shows the characteristic corckscrew appearance of the esophagus.
* Barium swallow shows the characteristic corckscrew appearance of the esophagus.
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*Patient may present with the symptoms of the underlying GERD.
*Patient may present with the symptoms of the underlying GERD.
*Dysphagia and odynophagia.
*Dysphagia and odynophagia.
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* Barium esophagography provides information about the site and the diameter of the stricture before the endoscopic intervention.
* Barium esophagography provides information about the site and the diameter of the stricture before the endoscopic intervention.
[[Image:Peptic stricture.png|center|300px|thumb|Peptic stricture - By Samir धर्म - From en.wikipedia.org, Public Domain, https://commons.wikimedia.org/w/index.php?curid=1931423]]
[[Image:Peptic stricture.png|center|300px|thumb|Peptic stricture - By Samir धर्म - From en.wikipedia.org, Public Domain, https://commons.wikimedia.org/w/index.php?curid=1931423]]
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<references />

Latest revision as of 15:22, 8 December 2017

Title
https://https://www.youtube.com/watch?v=0junqD4BLH4%7C350}}

DD

Nutcracker esophagus

  • Retrosternal chest pain that presents with or without food.
  • The condition is not progressive and not causing complications.


Barium swallow shows the characteristic corckscrew appearance of the esophagus.

Esophageal stricture

Manifestations Diagnostic tools
Achalasia
  • Dysphagia for solids and liquids is the most common feature, being seen in 91 % and 85% of patients respectively[2]
  • Regurgitation of undigested food occurs in 76-91% of patients[2]
  • Cough mainly when lying down in 30%[2]
 video trial
{{#ev:youtube|5ucSlgqGAno}}
  • Esophagogastroduodenoscopy findings include a dilated esophagus with residual food fragments, normal mucosa and occasionally candidiasis (due to the prolonged stasis).
  • Barium swallow shows the characteristic bird's beak appearance.
Barium swallow showing bird's beak appearance - By Farnoosh Farrokhi, Michael F. Vaezi. - Idiopathic (primary) achalasia. Orphanet Journal of Rare Diseases 2007, 2:38(http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2040141), CC BY 2.0, https://commons.wikimedia.org/w/index.php?curid=2950922
GERD
  • Retrosternal burning chest pain.
  • Cough and hoarseness of voice.
  • May present with complications such as strictures and dysphagia.
  • Upper GI endoscopy shows the complications such as esophagitis and barret esophagus.
  • Esophageal manometry may show decreased tone of the lower esophageal sphincter.
  • 24-hour esophageal pH monitoring may be done to confirm the diagnosis.
Barret's esophagus - By Samir धर्म - taken from patient with permission to place in public domain, Copyrighted free use, https://commons.wikimedia.org/w/index.php?curid=1595945
Esophageal carcinoma
  • Dysphagia
  • Odynophagia- fluids and soft foods are usually tolerated, while hard or bulky substances (such as bread or meat) cause much more difficulty
  • Weight loss
  • Pain, often of a burning nature, may be severe and worsened by swallowing, and can be spasmodic in character
  • Nausea and vomiting
  • Upper GI endoscopy and esophageal biopsy the gold standard for the diagnosis of esophageal
CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=2587715
Corckscrew esophagus
  • Retrosternal chest pain that presents with or without food intake.
  • The condition is not progressive and not causing complications.
  • Barium swallow shows the characteristic corckscrew appearance of the esophagus.
Corckscrew esophagus - Case courtesy of Radswiki, Radiopaedia.org, rID: 11680
Esophageal stricture
  • Patient may present with the symptoms of the underlying GERD.
  • Dysphagia and odynophagia.
  • Barium esophagography provides information about the site and the diameter of the stricture before the endoscopic intervention.
Peptic stricture - By Samir धर्म - From en.wikipedia.org, Public Domain, https://commons.wikimedia.org/w/index.php?curid=1931423
  1. ↑ Ferri, Fred (2015). Ferri's clinical advisor 2015 : 5 books in 1. Philadelphia, PA: Elsevier/Mosby. ISBN 978-0323083751.
  2. ↑ 2.0 2.1 2.2 Boeckxstaens GE, Zaninotto G, Richter JE (2013). "Achalasia". Lancet. doi:10.1016/S0140-6736(13)60651-0. PMID 23871090.
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