Achalasia Flashcards
1
Q
What is achalasia?
A
- Failure of smooth muscle relaxation of lower oesophageal sphincter.
- Progressive loss of peristaltic function
2
Q
Aetiology of achalasia?
A
Usually idiopathic. 2”/pseudoachalasia: malignancy, Chagas disease.
3
Q
Pathophysiology of achalasia?
A
Inflammatory degeneration of Auerbach’s plexus –> increase in LES pressure.
Incomplete relaxation of LES with swallowing, aperistalsis.
4
Q
Ix in achalasia?
A
- CXR: no air in stomach, dilated oesophagus
- Barium studies: oesophagus terminates in narrowing at LES (Bird’s beak)
- Endoscopy: r/o malignancy
- Manometry: definitive dx
5
Q
Rx achalasia?
A
-Dilation of LES with balloon +/- GERD prophylaxis.
50% good response; 5% risk perforation.
-Botox injection into LES
-Surgery (laparoscopic cardio myotomy)
6
Q
Symptoms of oesophageal motor disorders?
A
Dysphagia with solids and liquids. Chest pain (some disorders).
7
Q
Hx features of achalasia?
A
- Often lengthy Hx
- Progressive dysphagia S-> L
- Associated LoW
8
Q
Epidemiology of achalasia?
A
- 30-60y
- 1 per 100 000
9
Q
Typical symptoms of achalasia?
A
- Progressive dysphagia
- Odynophagia
- regurgitation
- profound weight loss
- malnutrition
