Achalasia

Question 1

Prevalence of achalasia

Answer 1

10/10000 people

Question 2

What is achalasia?

Answer 2

Dysfunction of the muscles of the oesophagus and failure of the lower oesophageal sphincter to open

Question 3

Symptoms of achalasia

Answer 3

Progressive dysphagia (difficulty swallowing), regurgitation, heartburn, chest pain, weight loss

Question 4

Aetiology of achalasia

Answer 4

Caused by idiopathic nerve damage (possibly caused by viral infection or toxin exposure), autoimmune disease, genetic

Question 5

How are different types of achalasia identified?

Answer 5

Immunotoxicity patterns

Question 6

Diagnosis of achalasia

Answer 6

Manometry (insertion of tube into oesophagus to measure pressure applied along oesophagus), barium swallow & x-ray, oesophagogastrodudenoscopy (OGD), biopsy

Question 7

Treatment of achalasia

Answer 7

Relaxants of oesophagus (e.g. nitrates), stretching the muscle via dilation with a balloon (under GA), botox injection into muscles, Heller’s myotomy (muscle fibres in lower oesophageal sphincter cut - may cause GERD)