Achalasia

Question 1

What is achalasia?

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. Achalasia typically presents in middle-age and is equally common in men and women.

Question 2

Clinical features of achalasia

Answer 2

• dysphagia of BOTH liquids and solids
• typically variation in severity of symptoms
• heartburn
• regurgitation of food
  
  • may lead to cough, aspiration pneumonia etc
• malignant change in small number of patients

Question 3

Investigations for suspected achalasia

Answer 3

• oesophageal manometry
  
  • excessive LOS tone which doesn’t relax on swallowing
  • considered the most important diagnostic test
• barium swallow
  
  • shows grossly expanded oesophagus, fluid level
  • ‘bird’s beak’ appearance
• chest x-ray
  
  • wide mediastinum
  • fluid level