Achalasia Flashcards
1
Q
What is achalasia?
A
It is the failure of oesophageal peristalsis and of relaxation of the lower oesophageal sphincter (LOS) due to degeneration of ganglia from Auerbach’s plexus.
EASY: LOS contracted & Oesophagus above dilated.
2
Q
What are some clinical features of achalasia?
A
- Dysphagia of BOTH liquids and solids
- Typically variation in severity of symptoms
- Heartburn
- Regurgitation of food - may lead to cough, aspiration pneumonia etc
- Malignant change in small number of patients
3
Q
What are some investigations that are done?
A
- Manometry: excessive LOS tone which doesn’t relax on swallowing - considered most important diagnostic test
- Barium swallow shows grossly expanded oesophagus, fluid level, ‘bird’s beak’ appearance
- CXR: wide mediastinum, fluid level
4
Q
How is it treated?
A
- Intra-sphincteric injection of botulinum toxin
- Heller cardiomyotomy
- Balloon dilation
- Drug therapy has a role but is limited by side-effects
