ACHALASIA

Question 1

What is it?

Answer 1

Failure of oesophageal peristalsis and of relaxation of the lower oesophageal sphincter (LOS) due to degenerative loss of ganglia from Auerbach’s plexus i.e. LOS contracted, oesophagus above dilated

Question 2

who?

Answer 2

middle age

men and women equal

Question 3

What is there dysphagia of?

Answer 3

both liquids and solids

Question 4

symptoms

Answer 4

dysphagia

heartburn

regurgitation of food

Question 5

risk of malignancy

Answer 5

in small amount of patients

Question 6

ix

Answer 6

oesophageal manometry - most important

barium swallow

CXR

Question 7

what does oesophageal manometry show?

Answer 7

excessive LOS tone which doesn’t relax on swallowing

considered the most important diagnostic test

Question 8

what does barium swallow show?

Answer 8

shows grossly expanded oesophagus, fluid level

‘bird’s beak’ appearance

Question 9

what does CXR show

Answer 9

wide mediastinum

fluid level

Question 10

Mx 1st line

Answer 10

1. pneumatic balloon dilation

Question 11

other Mx

Answer 11

surgical intervention with a Heller cardiomyotomy should be considered if recurrent or persistent symptoms

intra-sphincteric injection of botulinum toxin is sometimes used in patients who are a high surgical risk

drug therapy (e.g. nitrates, calcium channel blockers) has a role but is limited by side-effects