Achalasia, Esophageal Diverticula, and Gastritis: Symptoms and Treatments

Achalasia: Esophageal Motility Disorder

Achalasia is a disorder of esophageal motility characterized by decreased peristalsis and a failure of the lower esophageal sphincter (LES) to relax. The etiology is unknown. As the sphincter fails to relax, food accumulates in the lower esophagus within the thoracic cavity. The esophagus becomes dilated, its walls hypertrophied, and food does not pass until it accumulates enough to force its way through.

Clinical Manifestations of Achalasia

Symptoms result from the difficulty of food passing through the esophagus into the stomach. These may include:

• Food regurgitation
• Burning and retrosternal pain after meals, which may increase or decrease with movement

Diagnostic Procedures for Achalasia

Diagnosis is typically made by manometry, which indicates a lack of lower sphincter relaxation, absence of esophageal peristalsis, and increased intraesophageal pressure.

Treatment of Achalasia

The primary objective is to encourage expansion in the lower esophagus. Treatments may include:

• Nitrates or calcium channel blockers to relax the sphincter
• Esophageal balloon dilation (with a 5-15% risk of esophageal perforation)
• Surgical esophagomyotomy, making an incision over the sphincter to open the esophageal lumen, if balloon dilation fails or there is a high risk of perforation

Esophageal Diverticula: Sac-like Outpouchings

Esophageal diverticula are characterized by sac-like swellings in certain areas of the esophagus. When eating, food debris accumulates in these sacs, leading to compression of the trachea and causing dysphagia.

Clinical Manifestations of Esophageal Diverticula

• Regurgitation of food when diverticula are filled
• Halitosis (bad breath) due to putrefaction and fermentation of food waste
• Bitter taste in the mouth

Treatment of Esophageal Diverticula

If the clinical manifestations are mild, a soft or liquid diet may be recommended. In severe cases, surgical removal may be necessary.

Gastritis: Inflammation of the Stomach Lining

Gastritis is an inflammation of the gastric mucosa. It can be acute (transient) or chronic (long-term).

Acute Gastritis

Acute gastritis can have various causes, including:

• Irritants such as alcohol or tobacco
• Certain medications (aspirin, NSAIDs, etc.)
• Therapeutic procedures (chemotherapy, radiotherapy)
• Contaminated food
• Ingestion of corrosive substances

The process begins with hyperemia and edema of the gastric mucosa. Superficial erosions can progress to superficial ulceration and bleeding upon contact with acid.

Clinical Manifestations of Acute Gastritis

• Gastric pain
• Nausea and vomiting
• Hematemesis (vomiting blood)
• Melena (black, glossy, foul-smelling stool due to digested blood)

Chronic Gastritis

Chronic gastritis may be caused by gastric ulcers or infections by the bacterium Helicobacter pylori. In both acute and chronic cases, it can be difficult to establish the cause. The mucus becomes thick, and its cells degenerate, leading to a decrease in gastric secretion. The mucosa becomes less functional, thins, atrophies, and more gastric cells are lost.

Clinical Manifestations of Chronic Gastritis

Symptoms are similar to those of acute gastritis:

• Gastric pain
• Nausea and vomiting
• Sometimes, symptoms of Vitamin B12 deficiency (if associated with pernicious anemia due to a lack of intrinsic factor)

Diagnostic Procedures for Gastritis

A definitive diagnosis is made by:

• Endoscopy
• Mucosal biopsy
• Gastric analysis
• H. pylori test (e.g., breath test)