ACHALASIA

Impaired neuromuscular coordination of

the lower esophagus due to disrupted
innervation
Impaired swallowing due to:
• Decreased peristalsis in the middle
esophagus○ Lower esophageal sphincter
(LES) maintains an excessively high tone
and fails to open properly
duringswallowing
• Food is prevented from entering the
stomach, causing esophageal distention
SYMPTOMS
DIETARY TREATMENT
• FOOD TO EAT
• Dairy products
• white fish(not fried)
• Chicken,tender beef, mutton
• Margarine, ghee (in cooking)
• Rice, semonila,cornflour for pudding
• Ice-cream
• Potatoes, green veges, yellow root
vegetable(mashed/pureed)
• Fruits(cooked, pureed, and seived)
• Ripe raw bananas
• weak tea
• additional sources of vitamin C
• FOOD TO AVOID
• Fried foods
• tough meat, salted fish, fatty fish
(hista, herring&sardines)
• very fresh bread, cake , biscuits,
puddings containing dried food
• raw fruit, dried fruit, nuts &peels
• raw onions, radish,
cucumber,celery & tomato
• pickles, spices, condiments
• strong tea, coffee & alcohol
 OESOPHAGUL STRICTURE
• narrowing of oesophagus
• results in dysphagia i.e it makes difficult
to swallow
• it can progress from difficulty swallowing
solid foods to soft foods, and then to
semisolid foods.
Treatment
• liquid diet is recommended
• surgical dilation of the
oesphagus
• celestian tube is inserted into
oesophagus to keep it open
• fluid diet is recommened for
patient with celestian tube
GUIDELINES FOR USING CELESTIAN
TUBE
• chew the food well. Food should be free of bones and gristles
• take care with food that can be swallowed as whole i.e. segments of
canned fruits, vegetavles and tough meat
• take vitamin C supplement daily
• clean the tube after every meal with solution containing 4 oz sugar, 4
oz tataric acid, 4 oz bicarbonate of soda. Mix one teaspoonful of them
in 1 glass of water and take after each meal
• patient dietary intake should be reviewed periodicaly
• nourishing drinks such as milk with egg or milk with ovaltine/sustagin
should be given to undernourished patients
HIATAL HERNIA
An abnormal condition in which part
of stomach proytrudes upward
through esophageal cleft in the
diaghram sometimes causing a
backflow of acid and stomach
contents into esophagus
CAUSES
• weaking of the attachment of
oesophagus in middle age
• obesity( increased bulk of abdominal
contetnts put more pressure on hiatus)
• Chronic cough
Problems associated with Hiatus Hernia
• It can be asymptomatic
• may result in reflux oesophagitis
• Gastritis can occur in the part of
protruding stomach, may cause
bleeding and anemia
REFLUX OESOPHAGITIS
• Reflux esophagitis, also known Symptoms
as gastroesophageal reflux • Heartburn
disease (GERD), is a condition
where stomach acid and • pain below chest
contents flow back up into the • regurgitation
esophagus, causing • symptoms appear 30-60 after
inflammation and irritation of
the esophageal lining meal
REFLUX OESOPHAGITIS
CAUSES Complications
• hiatus hernia • oesophageal ulceration
• pregnancy • narrowing of oesophageal canal
• obesity (stenosis)
• contiual vomiting • Anemia
• Coughing
• breathlessness
GENERAL RECOMMENDATIONS
• no dietray changes are recommended for patient unless patient is
overweight
• patient of normal weight is encouraged to eat nutritious diet
• patient should aviod lying down after meal
• should sleep with head raised
• antacids are given
• gastrocote coats the surface of oesophagus, protecting from acid