Achalasia

Question 1

What is achalasia?

Answer 1

Condition that results in the failure of oesophageal peristalsis and relaxation of the lower oesophageal sphincter due to degeneration of the myenteric plexus

Question 2

Name 2 clinical features/ symptoms of achalasia

Answer 2

• Dysphagia
• Regurgitation of food that can lead to aspiration, pneumonia etc
• Weight loss
• Heartburn

Question 3

What are the 3 investigations that can be done?

Answer 3

• Barium swallow
• Endoscopy
• Oesophageal manometry

Question 4

1) Name 1 thing a barium swallow may show
2) Name 1 thing an endoscopy may show
3) Name 1 thing an oesophageal manometry may show
4) Which of these is considered to be the most important diagnostic method?

Answer 4

1) Grossly expanded oesophagus, ‘bird beak’ appearance
2) Dilated oesophagus, containing residual material
3) High pressure and incomplete lower oesophageal sphincter relaxation
4) Oesophageal manometry

Question 5

1) Name a medical treatment
2) Name a surgical treatment
3) What is the first line treatment in patients that are a low surgery risk?

Answer 5

1) Botulinum toxin injections, calcium channel blockers, nitrites
2) Oesophageal dilatation and surgical cleavage of the muscle - ‘Heller cardiomyotomy’
3) Endoscopic pneumatic (balloon) dilation

Question 6

What tumour does achalasia increase the risk of?

Answer 6

Squamous cell carcinoma of oesophagus