achalasia Flashcards
what is achalasia
intermittent dysphagia and impaired relaxation of LOS
what are the symptoms
intermittent dysphagia for solids and liquids regurgitation chest pain - spasm halitosis weight loss
when is regurgitation worse
at night - gravity
what is the onset like
slow - prolonged history
reduced secretion of what is linked to its development
NO
investigations
CXR
barium swallow
Oesophagoscopy
manometry
what does Oesophagoscopy do
is performed to exclude a carcinoma and the lower end of the oesophagus - as there is an inc risk of Squamous CC
what does CXR show
narrowing tapering distal oesophagus
fluid level behind heart
what does barium swallow show
bird beak appearance due to failure of sphincter to relax and lack of peristalsis
what does manometry show
aperistalsis of oesophagus and failure of LOS to relax
what is the treatment
palliative
surgical options
endoscopic balloon dilatation
hellers cardiomyotomy and PPI
what pharmacological intervention is also useful
Ca channel blockers and nitrates also relax the sphincter
what is the problem with endoscopic balloon dilatation
50% patients require a 2nd or 3rd one within the first 5 years
how many times must hellers cardiomyotomy be done
once
