Achalasia Flashcards
What is achalasia?
The in ability for the smooth muscle of the lower oesophagus to relax. This causes the lower oesophageal sphincter to remain closed.
Can achalasia occur throughout the GI tract? Give an example
Yes, for example Hirschprung’s disease (achalasia of the large bowel)
What do you have to make sure before diagnosing achalasia?
That there aren’t other causes such as a cancer or fibrosis
What are the signs and symptoms of achalasia?
- Dysphagia
- Chest pain
- Regurgitation
- Weight loss
- Aspiration of fluids
What is the pathophysiology of achalasia?
- LES pressure and relaxation is controlled be neurotransmitters (excitatory - acetylcholine and inhibitory - NO)
- People with achalasia lack the noradrenergic, noncholinergic and inhibitory ganglion cells
- this causes an inability for the smooth muscle to relax.
- The cause to this may be due to an inflammatory immune response
What is used for diagnosis?
Barium swallow
Oesophageal manometry
Endoscopy
What do you look for on barium swallow?
Birds beak on LES
What does the oesophageal manometry look for?
The probe will measure the contractions throughout the oesophagus during their swallow. It will show the how LES has the inability to relax. - A higher pressure in the LES
- Aperistalsis
Is a biopsy needed?
No often
What is the treatment for mild/moderate achalasia?
CCB - Sublingual nifiepine
Nitrates
What are other forms of treatment?
- Botox
- Myotomy
- Endoscopic myotomy
- Pneumatic dilation
What is pneumatic dilation?
Lower oesophageal muscle is stretched and torn with the inflation of the balloon
What is a common complication post surgical intervention?
GORD
How is a Heller’s Myotomy done?
- Done laparoscopic
- Makes a longitudinal cut from LES to stomach
- The cut is only the outside layers of the muscle not the inside
