Idiopathic (Primary) Achalasia

Idiopathic achalasia is a primary esophageal motor disorder characterized by esophageal aperistalsis and abnormal lower esophageal sphincter (LES) relaxation in response to deglutition. It is a rare disease with an annual incidence of approximately 1/100,000 and a prevalence rate of 1/10,000. The disease can occur at any age, with a similar rate in men and women, but is usually diagnosed between 25 and 60 years. It is characterized predominantly by dysphagia to solids and liquids, bland regurgitation, and chest pain. Weight loss (usually between 5 to 10 kg) is present in most but not in all patients. Heartburn occurs in 27%–42% of achalasia patients. Etiology is unknown. Some familial cases have been reported, but the rarity of familial occurrence does not support the hypothesis that genetic inheritance is a significant etiologic factor. Association of achalasia with viral infections and auto-antibodies against myenteric plexus has been reported, but the causal relationship remains unclear. The diagnosis is based on history of the disease, radiography (barium esophagogram), and esophageal motility testing (esophageal manometry). Endoscopic examination is important to rule out malignancy as the cause of achalasia. Treatment is strictly palliative. Current medical and surgical therapeutic options (pneumatic dilation, surgical myotomy, and pharmacologic agents) aimed at reducing the LES pressure and facilitating esophageal emptying by gravity and hydrostatic pressure of retained food and liquids. Although it cannot be permanently cured, excellent palliation is available in over 90% of patients.

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Achalasia: Causes, Symptoms, and Treatments

Principal Symptoms of Achalasia

• Reflux (regurgitation of food, fluids, and acids)
• Chest pain, which may increase after eating or may be felt in the back, neck, and arms
• Cough
• Dysphagia - Difficulty swallowing food and liquids
• Heartburn
• Difficulty belching
• Unintentional weight loss Bibliography item medline not found.,Bibliography item farrokhi not found.

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Sternocleidomastoid Muscle: Location, Action and Trigger Points

Headaches of a myofasical origin are referred to as myogenic headaches.¹ and the pain from these types of headaches is most often felt in the lower back portion of the head, termed the occipital area. Trigger points in the trapezius muscle and various muscles of mastication can also contribute to myogenic headaches so should be treated concurrently.²

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