Achalasia Flashcards
What is Achalasia?
Failure of oesophageal peristalsis and of relaxation of the lower oesophageal sphincter (LOS) due to degenerative loss of ganglia from the myenteric (Auerbach’s) plexus
LOS contracted, oesophagus above dilated.
At what age does Achalasia typically present?
Middle-age
Achalasia is equally common in men and women.
What are the clinical features of Achalasia?
- Dysphagia of BOTH liquids and solids from BEGININNIG
- Variation in severity of symptoms
- Heartburn
- Regurgitation of food
- May lead to cough, aspiration pneumonia etc
- Malignant change in small number of patients
What is the most important diagnostic test for Achalasia?
Oesophageal manometry
Shows excessive LOS tone which doesn’t relax on swallowing.
What does a barium swallow show in cases of Achalasia?
- Grossly expanded oesophagus
- Fluid level
- ‘Bird’s beak’ appearance
What does a chest x-ray reveal in Achalasia?
- Wide mediastinum
- Fluid level
What is the preferred first-line treatment for Achalasia?
Pneumatic (balloon) dilation
It is less invasive and has a quicker recovery time than surgery.
Under what conditions should surgical intervention be considered for Achalasia?
If recurrent or persistent symptom with Heller cardiomyotemy.
Surgery may be required if complications occur.
What is a treatment option for high surgical risk patients with Achalasia?
Intra-sphincteric injection of botulinum toxin
What role does drug therapy play in the treatment of Achalasia?
Limited by side effects
Examples include nitrates and calcium channel blockers.
True or False: Achalasia can lead to aspiration pneumonia.
True
Urgent Referral criteria for oesophageala nd stomach cancer?
Patients aged >= 55 years who’ve got weight loss, AND any of the following:
upper abdominal pain
reflux
dyspepsia
Non urgent referral criteria?
Patients aged >= 55 years who’ve got:
treatment-resistant dyspepsia or
upper abdominal pain with low haemoglobin levels or
raised platelet count with any of the following: nausea, vomiting, weight loss, reflux, dyspepsia, upper abdominal pain
nausea or vomiting with any of the following: weight loss, reflux, dyspepsia, upper abdominal pain
What is the key investigation for dysphagia?
Upper GI endoscopy
What does ptosis or extraocuar muscle weakness indicate with dysphagia?
Myasthenia gravis, causing solid and liquid dysphagia
What cause of dysphagia is associated with heartburn?
Oesophagitis that causes painful swallowing/odynophagia.
Where does pharyngeal pouch occur?
between thyropharyngeus and cricopharyngeus muscles
Usually not seen but if large then a midline lump in the neck that gurgles on palpation
How does systemic sclerosis cause dysphagia?
Reduced lower PEsopageal pressurere causes acid reflux and oesopahgeal dysmotility.
What are the featureses of systemic sclerosis?
CREST syndrome namely C=Calcinosis, R=Raynaud’s phenomenon, E=oEsophageal dysmotility, S=Sclerodactyly, T= Telangiectasia
What is globus hysterics?
Intermittent Feeling of painless lump in the throat, associated with history of anxiety.
What is oesopeageal web?
Associated with severe iron deficiency anaemia in Plummer Vinson syndrome
What is Mallory Weiss syndrome associated with?
Severe vomiting → painful mucosal lacerations at the gastroesophageal JUNCTION resulting in haematemesis. Common in alcoholics
What is the cause of Boerhaave syndrome?
Severe vomiting causing severe oesophageal RUPTURE
