Achalasia

Question 1

Cause of achalasia

Answer 1

failure of lower oesophageal sphincter to relax

=> oesophagus above dilated and sphincter itself contracted

Question 2

What nerve plexus controls the lower oeseophageal sphincter?

Answer 2

Auerbach’s plexus

Question 3

What demographic typically develop achalasia?

Answer 3

• middle-aged
• equally common in men and women.

Question 4

Clinical features of achalasia

Answer 4

• dysphagia of BOTH liquids and solids
• heartburn
• regurgitation of food (may lead to aspiration)
• malignant change in small number of patients

Question 5

Investigations of achalasia

Answer 5

oesophageal manometry
> excessive LOS tone even on swallowing (DIAGNOSTIC)

barium swallow
> ‘bird’s beak’ appearance

chest x-ray
- wide mediastinum
- fluid level

Question 6

Management of achalasia

Answer 6

• balloon dilation
• surgery - Heller cardiomyotomy
• intra-sphincteric injection of botox
• drug therapy (e.g. nitrates, calcium channel blockers) has a role but is limited by side-effects