Resumo
Definição
História e exame físico
Principais fatores diagnósticos
- disfagia
Outros fatores diagnósticos
- postura para auxiliar na deglutição
- pressão/dor retroesternal
- regurgitação
- perda de peso gradual
- pirose
- alimentação lenta
- tosse/sufocamento na posição de decúbito
- infecções torácicas recorrentes
- sensação de nó na garganta (globus)
- soluços
Fatores de risco
- vírus do herpes e sarampo
- doença autoimune
- antígenos leucocitários humanos (HLA) classe II
- pais consanguíneos
- síndrome de Allgrove (triplo A)
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- endoscopia digestiva alta
- esofagografia baritada
- manometria esofágica de alta resolução
Investigações a serem consideradas
- radiografia torácica
- estudos do esvaziamento esofágico por radionucleotídeos
- esofagograma com bário cronometrado
- tomografia computadorizada (TC) do tórax
- planimetria por impedância
Algoritmo de tratamento
pacientes que aguardam tratamento definitivo
bom candidato cirúrgico
não candidato à cirurgia
Colaboradores
Autores
Jamal Omar Hayat, MBBS, BSc, MRCP, MD (Res)
Consultant Gastroenterologist and Honorary Senior Lecturer
Department of Gastroenterology
St George's University Hospitals NHS Trust
London
UK
Declarações
JOH declares that he has no competing interests.
Kalliopi Alexandropoulou, MD, FRCP
Consultant Gastroenterologist
Royal Surrey County Hospital
Guildford
Surrey
UK
利益声明
KA declares that she has no competing interests.
鸣谢
Dr Jamal Omar Hayat and Dr Kalliopi Alexandropoulou wish to gratefully acknowledge Dr Jin-Yong Kang, the previous contributor to this topic.
利益声明
JYK declares that he has no competing interests.
同行评议者
Nigel Trudgill, MB ChB
Consultant Gastroenterologist
Sandwell General Hospital
West Bromwich
UK
利益声明
NT declares that he has no competing interests.
John de Caestecker, BChir
Consultant in General Medicine
Leicester General Hospital
Leicester
UK
利益声明
JdC declares that he has no competing interests.
David Hackam, MD, PhD
Assistant Professor of Surgery
Children's Hospital of Pittsburgh
Pittsburgh
PA
利益声明
DH declares that he has no competing interests.
George Y. Wu, MD, PhD
Professor of Medicine
University of Connecticut Health Center
Farmington
CT
利益声明
GYW is on the medical advisory boards of the following: Gilead Sciences, Bristol-Myers Squibb, AbbVie, and Intercept.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
参考文献
关键文献
Zaninotto G, Bennett C, Boeckxstaens G, et al. The 2018 ISDE achalasia guidelines. Dis Esophagus. 2018 Sep 1;31(9).全文 摘要
Vaezi MF, Pandolfino JE, Yadlapati RH, et al. ACG clinical guidelines: diagnosis and management of achalasia. Am J Gastroenterol. 2020 Sep;115(9):1393-411.全文 摘要
参考文献
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
鉴别诊断
- Carcinoma esofágico
- Esofagite de refluxo
- Doenças do tecido conjuntivo (por exemplo, esclerose sistêmica)
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- Adverse events associated with EGD and EGD-related techniques
- Diagnosis and management of achalasia
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