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Cricopharyngeal Achalasia Definition, Symptoms, Causes, Treatment

   

The upper esophageal sphincter (UES) and lower esophageal sphincter (LES) is a musculoskeletal valve made up of cricopharyngeus muscle. The UES function  is to provide pathway for the passage of components between the pharynx and the esophagus, it normally relax at the process of swallowing for allowing the passage of food bolus. It keeps air from entering the esophagus, allows swallowed material to pass into the esophagus and prevents the esophageal contents into the pharynx. It occurs mostly due to neurological disease and diagnosed late.

Achalasia is motor disorder of the esophagus. Nerve cells that is located between the esophageal muscle layers are damage or degenerate, resulting in complete loss of esophageal contractions and failure of lower esophageal sphincter relaxation.When the lower and upper esophageal sphincter muscle fails to relax,  it causes complete resistance and destruction in esophagogastric junction in addition, loss of effective coordination and propulsion. it will lead to dysphagia. The defective opening of UES may also cause swallowing problems and esophageal muscle weakness. . Long term dysphagia may also be the reason of cricopharyngeal achalasia. Patient suffering from this disorder are usually above 40 years of age and most commonly above 60. Clinical study found that achalasia mostly caused by solid food dysphagia.


Cricopharyngeal Achalasia Symptoms


Food is chewed but it goes round and round, and does not go down. feeling of bolus in throat, chocking, aspiration of food, weight loss may also occur. Feeling of food sticking in the throat or chest. Coughing is also a response due to different stimuli originating in the lungs, pharynx and larynx. Occurring of cough before and after swallowing, this symptom strongly diagnose the swallowing problem. Chest discomfort or pain is also seen in some patient. Severity of symptoms may vary depending upon the narrowing of sphincter, motor dysfunction, and food variety. Patients may complain sticking of food in case of liquids and solid.

Cricopharyngeal Achalasia Definition, Symptoms, Causes, Treatment

Cricopharyngeal Achalasia Causes


Cricopharyngeal spasm are caused by neurological conditions or due to damaging nerves causing stroke e.t.c. it can also be caused by muscular spasm of cricopharyngeus muscle or muscle dysfunction. This dysfunction or muscular spasm leads to dysphagia or cause difficulty in swallowing. Cricopharyngeus achalasia can also be caused by muscle fiber necrosis, abnormal fiber structure, basophilic fibers and fibrosis process. Protective cough is also the cause of cricopharyngeus achalasia. Problem may fall in the era of gastroesophageal reflux disease (GERD) as major factor, as compared to swallowing disorder. Muscle disorder, sphincter dysfunction and spastic disorder are also the cause of Cricopharyngeus achalasia.

Cricopharyngeal Achalasia Treatment


Treatment of cricopharyngeal achalasia include muscle relaxants and also includes botilium toxin injection that injects in cricopharngeal muscle which is used as a trial of therapy, but the effect of botilium toxin injection is for short term relief. patients undergo repeated doses to maintain therapeutic effect. Dietary modification results in reducing aspiration. Surgical treatments are performed for improving pharyngeal clearance and aspiration purpose. Anticholinergic drugs have been associated with decrease in peristalsis.calcium channel blockers may also given for reducing lower esophageal sphincter pressure.Swallowing therapy is recommended for neurogenic dysphagia. Dilator system is used to increase the diameter of swallowing channel.

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