Achalasia other imaging findings: Difference between revisions

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{{Achalasia}}
{{Achalasia}}
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==Overview==
==Overview==
[[Esophagogastroduodenoscopy]] is complementary to [[manometry]] in diagnosing achalasia. It is indicated primarily to rule out any mechanical obstruction or pseudoachalasia (neoplastic iniltration).


==Other Imaging Findings==
[[Esophagogastroduodenoscopy]] is complementary to [[manometry]] in diagnosing achalasia.  It is indicated primarily to rule out any mechanical obstruction or pseudoachalasia (neoplastic iniltration).
==Esophagogastroduodenoscopy==
==Esophagogastroduodenoscopy==
* Most patients should get an EGD – primarily in order to rule out any mechanical obstruction and malignancy (esophageal and gastric).
* Most patients should get an EGD – primarily in order to rule out any mechanical obstruction and malignancy (esophageal and gastric).
*:* Findings include a dilated esophagus with residual food fragments, normal mucosa and occasionally [[candidiasis]](due to the prolonged stasis).
*:* Findings include a dilated esophagus with residual food fragments, normal mucosa and occasionally [[candidiasis]] (due to the prolonged stasis).
*:* Factors associated with an increased risk of [[malignancy]] include symptoms less than 6 months, presentation after 60 years old, excessive weight loss and difficult passage of the endoscope through the [[gastroesophageal junction]].
*:* Factors associated with an increased risk of [[malignancy]] include symptoms less than 6 months, presentation after 60 years old, excessive weight loss and difficult passage of the endoscope through the [[gastroesophageal junction]].
* In cases diagnosed with GERD, endoscopic findings of dilated esophagus, retained food in esophagus can help diagnose achalasia correctly.
* In cases diagnosed with [[GERD]], endoscopic findings of dilated esophagus, retained food in esophagus can help diagnose achalasia correctly.
* In cases undergoing endoscopy for dysphagia, esophageal biopsies are recommended to rule out eosinophilic esophagitis. However if the endoscopic picture is very clear for achalasia, biopsy is not recommended.<ref name="pmid23877351">{{cite journal| author=Vaezi MF, Pandolfino JE, Vela MF| title=ACG clinical guideline: diagnosis and management of achalasia. | journal=Am J Gastroenterol | year= 2013 | volume= 108 | issue= 8 | pages= 1238-49; quiz 1250 | pmid=23877351 | doi=10.1038/ajg.2013.196 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23877351  }} </ref>
* In cases undergoing [[endoscopy]] for dysphagia, esophageal biopsies are recommended to rule out [[eosinophilic esophagitis]]. However if the endoscopic picture is very clear for achalasia, biopsy is not recommended.<ref name="pmid23877351">{{cite journal| author=Vaezi MF, Pandolfino JE, Vela MF| title=ACG clinical guideline: diagnosis and management of achalasia. | journal=Am J Gastroenterol | year= 2013 | volume= 108 | issue= 8 | pages= 1238-49; quiz 1250 | pmid=23877351 | doi=10.1038/ajg.2013.196 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23877351  }} </ref>
 
 
'''Achalasia in a patient with Allgrove syndrome'''
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'''Cricopharyngeal achalasia'''
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{{#ev:youtube|ydLcskQzEjM}}


==References==
==References==

Latest revision as of 13:42, 13 November 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1], Associate Editor(s)-in-Chief: Ahmed Younes M.B.B.CH [2]

Overview

Esophagogastroduodenoscopy is complementary to manometry in diagnosing achalasia. It is indicated primarily to rule out any mechanical obstruction or pseudoachalasia (neoplastic iniltration).

Esophagogastroduodenoscopy

  • Most patients should get an EGD – primarily in order to rule out any mechanical obstruction and malignancy (esophageal and gastric).
    • Findings include a dilated esophagus with residual food fragments, normal mucosa and occasionally candidiasis (due to the prolonged stasis).
    • Factors associated with an increased risk of malignancy include symptoms less than 6 months, presentation after 60 years old, excessive weight loss and difficult passage of the endoscope through the gastroesophageal junction.
  • In cases diagnosed with GERD, endoscopic findings of dilated esophagus, retained food in esophagus can help diagnose achalasia correctly.
  • In cases undergoing endoscopy for dysphagia, esophageal biopsies are recommended to rule out eosinophilic esophagitis. However if the endoscopic picture is very clear for achalasia, biopsy is not recommended.[1]

{{#ev:youtube|ydLcskQzEjM}}

References

  1. Vaezi MF, Pandolfino JE, Vela MF (2013). "ACG clinical guideline: diagnosis and management of achalasia". Am J Gastroenterol. 108 (8): 1238–49, quiz 1250. doi:10.1038/ajg.2013.196. PMID 23877351.

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