Achalasia

Question 1

What is achalasia?

Answer 1

Achalasia is a condition of unknown aetiology which causes failure of the lower oesophageal sphincter to relax.

Question 2

How does achalasia present?

Answer 2

Dysphagia – gradual onset (months to years)
Regurgitation of undigested food
Aspiration
Retrosternal chest pain / heartburn – often does not respond to PPI
Weight loss – often mild

Question 3

What investigations would you do for achalasia?

Answer 3

1. Endoscopy – may show dilated oesophagus, containing residual material. It also rules out other more sinister pathologies.
2. Oesophageal manometry – shows high pressure and incomplete lower oesophageal sphincter relaxation
3. Barium swallow – shows classic ‘bird’s beak appearance’ in advanced disease

Question 4

How would you treat achalasia?

Answer 4

Botox, CCB/nitrates or surgery