Achalasia Flashcards
What is achalasia?
It is defined as a condition in which there is failure of oesophageal peristalsis and contraction of the lower oesophageal sphincter
What is the pathophysiological cause of achalasia?
It is due to a degenerative loss of ganglia within the Auerbach’s nerve plexus
What are the six clinical features of achalasia?
Dysphagia of Liquids & Solids
Heartburn
Regurgitation
Aspiration Pneumonia
Nausea & Vomiting
Weight Loss
What are the three investigations used to diagnose achalasia?
Chest X-Ray (CXR)
Barium Swallow
Oesophageal Manometry
What are the two CXR features of achalasia?
Widened Mediastinum
Air-Fluid Level
What are the three features of achalasia on barium swallow?
Widened Oesophagus
Air-Fluid Level
Bird’s Beak Sign
What is the birds beak sign on CXR?
It is the appearance of a tight stricture at the gastrooesophageal junction
What is the gold standard investigaion used to diagnose achalasia?
Oesophageal manometry
What is oesophageal manometry?
It involves a catheter being inserted through the nose and passed into the oesophagus
This allows measurement of the oesophageal sphincter tone and the force exerted by oesophageal muscles
What is a feature of achalasia on oesophageal manometry?
Excessive lower oesophageal sphincter tone, which doesn’t relax on swallowing
What are the two pharmacological management options used to manage achalasia?
Calcium Channel Blockers
Nitrates
When are calcium channel blockers used to manage achalasia?
When individuals are unsuitable for pneumatic dilation or surgical management, and botulinum injections have been deemed as unsuccessful
However, it is important to note that there is limited treatment effect with several side effects
Name a calcium channel blocker used to manage achalasia
Nifedipine
When are nitrates used to manage achalasia?
When individuals are unsuitable for pneumatic dilation or surgical management, and botulinum injections have been deemed as unsuccessful
However, it is important to note that there is limited treatment effect with several side effects
Name a nitrate used to manage achalasia
Nitroglycerin
What are the two non-surgical management options used to manage achalasia?
Pneumatic Dilation
Botulinum Toxin Injection
When is pneumatic dialtion used to manage achalasia?
It is the first line management option of achalasia, in young individuals without multiple comorbidities
What is pneumatic dilation?
It involves endoscopic insertion of a balloon into the oesophageal sphincter and inflated to enlarge the opening
When is botulinum toxin injections used to manage achalasia?
It is the first line management option of achalasia, in elderly individuals with multiple comorbidities
How are botulinum toxin injections used to manage achalasia?
It is injected into the oesophageal sphincteric muscle to relax it
What is the surgical management option of achalasia?
Heller Cardiomyotomy
When is heller cardiomyotomy used to manage achalasia?
It should be considered in cases where achalasia is recurrent, and individuals are young without multiple comorbidities
What is heller cardiomyotomy?
It involves an incision of the muscle at the lower end of the oesophageal sphincter
