Achalasia with megaesophagus

Health

Achalasia with megaesophagus

Published

1 year ago

May 14, 2023

A 29-year-old man presented to the emergency department with worsening heartburn and regurgitation, despite taking proton pump inhibitors and antacids for several months. He had a 10-year history of dyspepsia with dysphagia of solid and liquid food. We obtained a chest radiograph (Appendix 1, available at www.cmaj.ca/lookup/doi/10.1503/cmaj.230111/tab-related-content), which showed lateralization of the azygoesophageal recess with a right posterior mediastinal mass density. A computed tomography (CT) scan showed a markedly dilated esophagus with a thick, calcified wall (Figure 1A). An upright barium esophagram (Figure 1B) showed a dilated proximal esophagus with distal narrowing in a bird’s beak morphology (arrow). Suspecting achalasia or esophageal cancer causing pseudoachalasia, we arranged for the patient to undergo upper endoscopy, which showed no evidence of tumour and was consistent with achalasia. He underwent a peroral endoscopic myotomy (POEM). At 2-year follow-up, he was doing well, with good oral intake and an Eckhardt score (a clinical score for achalasia) that had improved from 12 to 1.

<a href=”https://www.cmaj.ca/content/cmaj/195/19/E684/F1.large.jpg?width=800&height=600&carousel=1″ title=”(A) Computed tomography scan of a 29-year-old man with achalasia, showing a markedly dilated esophagus with a thick, calcified wall. (B) An upright barium esophagram showed a bird’s beak morphology (arrow) that resulted from failure of the lower esophageal sphincter to relax during swallowing.” class=”highwire-fragment fragment-images colorbox-load” rel=”gallery-fragment-images-382665731″ data-figure-caption=”

(A) Computed tomography scan of a 29-year-old man with achalasia, showing a markedly dilated esophagus with a thick, calcified wall. (B) An upright barium esophagram showed a bird’s beak morphology (arrow) that resulted from failure of the lower esophageal sphincter to relax during swallowing.

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Figure 1:

Achalasia is an esophageal motility disorder characterized by insufficient relaxation of the lower esophageal sphincter and absence of peristalsis.1 It is uncommon and occurs equally in both genders and across all races.1 Mean age at diagnosis is older than 50 years but it can be seen in children and young adults.1 Presenting symptoms include progressive dysphagia for solids and liquids (90%), heartburn (75%), regurgitation of undigested food (45%) and respiratory complications, including nocturnal cough and aspiration (20%–40%).2 For patients with dysphagia who have intact oropharyngeal swallowing, mechanical obstruction should be excluded via either endoscopy or a CT scan, before assessing for abnormal motility with esophageal manometry.1^,2 Treatment options for achalasia include injection with botulinum toxin, pneumatic dilation, laparoscopic Heller myotomy and, more recently, POEM; these relieve symptoms by reducing the hypertonic contraction of the lower esophageal sphincter, improving esophageal emptying. Choice of treatment should be based on the availability of local expertise, patient preferences, cost and patient suitability for the intervention.3

Footnotes

Competing interests: None declared.
This article has been peer reviewed.
The authors have obtained patient consent.

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY-NC-ND 4.0) licence, which permits use, distribution and reproduction in any medium, provided that the original publication is properly cited, the use is noncommercial (i.e., research or educational use), and no modifications or adaptations are made. See: https://creativecommons.org/licenses/by-nc-nd/4.0/

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Health

Update on Whooping Cough Outbreak in the Eastern Zones – NTV News

Published

10 hours ago

July 6, 2024

Harry Miller

NL Health Services has provided an update on the outbreak of whooping cough in the eastern zones of the province.  

As of Wednesday, there have been 151 cases of whooping cough reported. Over half of these cases are among children between the ages of 10 and 14, with the age of affected individuals ranging from one month to 89 years.

NL Health Services is launching a social media campaign to encourage individuals, especially those who will be around a new baby, to get vaccinated against whooping cough.

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No further TB cases identified in Yellowknife so far, says GNWT – Cabin Radio

Published

11 hours ago

July 6, 2024

Harry Miller

The NWT government says a tuberculosis outbreak declared in Yellowknife earlier this week remains at two cases so far.

Even so, the territory’s health authority said Yellowknife Public Health would remain “on reduced services until further notice” to ensure the system has capacity if the outbreak worsens.

An exposure notice remains in place for people who were at Stanton Territorial Hospital’s emergency room for a period on June 19. Anyone who believes they may be affected should call 811.

The GNWT has said that notice was issued “for precautionary reasons only” and has sought to reassure residents that most people needn’t worry.

“Most people exposed to someone with TB never get infected or go on to develop disease,” the territory stated earlier this week.

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Symptoms can include a cough, fever, night sweats, weight loss, chest pain and bloody sputum.

Some health services have been reduced in response to a TB concern since Friday last week. The outbreak was announced on Wednesday this week.

“As of July 5 at 1:50pm, there are still only two confirmed cases in Yellowknife. Public Health continues its contact tracing operations and there are no further updates at this time,” a Department of Health and Social Services spokesperson stated by email.

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Virtual ER Availability at Dr. Y. K. Jeon Kittiwake Health Centre

Published

22 hours ago

July 5, 2024

Harry Miller

Posted: July 5, 2024

Newfoundland and Labrador (NL) Health Services advises the public of the following temporary changes to the availability of emergency services at Dr. Y.K. Jeon Kittiwake Health Centre in New-Wes-Valley due to human resource challenges. On-site emergency services are being supported through a Virtual ER physician from:

Sunday, July 7 at 8:00 a.m. until Tuesday, July 9 at 8:00 a.m.

When a Virtual ER is operating, residents can proceed to the ER at Dr. Y. K. Jeon Kittiwake Health Centre as usual. There will be a health-care professional onsite, as well as a physician or nurse practitioner (NP) by video. For more on Virtual ERs, please visit our website.

Other Information: NL Health Services’ Health Hub is available to ALL residents of Central Newfoundland who have non-emergent medical issues, who do not have a family physician or whose family physician is not available. Health Hub clinics are open Monday to Friday from 8:00 a.m. to 8:00 p.m. and Saturday and Sunday from 12:00 p.m. to 6:00 p.m. Hours of operation are dependent on physician availability. To reach the Health Hub, please call the Gander Medical Clinic at 709-381-0112 or 709-381-0338 or the Killick Clinic in Grand Falls-Windsor at 709-292-8404. Patients should expect an increase in wait times for both in person and virtual appointments at Health Hub sites.

For more information on Health Hubs, please visit our website.

811 HealthLine is available 24/7 to provide:

medical advice (including virtual nurse practitioner appointments which can usually be accommodated within three days);
health information; and
support in a mental health crisis.

For more information, please visit: https://www.811healthline.ca/.

For the most up-to-date information on temporary service closures throughout the province, please visit: https://nlhealthservices.ca/find-health-care/updates/.

NL Health Services thanks the public for their understanding as we continue to focus on providing safe and quality care for people of the New-Wes-Valley area.

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