Achalasia

Question 1

Description: What is achalasia?

Answer 1

Oesophageal motility disorder where there is functional loss of the myenteric plexus ganglion cells in the distal oesophagus and lower oesophageal sphincter

Question 2

Description: What happens to peristalsis and the LOS in achalasia?

Answer 2

• Peristalsis is lost

- LOS fails to relax, making it difficult for foods and liquids to reach the stomach

Question 3

Aetiology/Risk Factors XXX

Answer 3

XXX

Question 4

Pathology: What is the pathology that underlies achalasia?

Answer 4

• Degeneration of inhibitory neurons (ganglion cells) in the myenteric plexus ganglion cells in distal oesophagus and lower oesophageal sphincter

Question 5

Symptoms: What are the symptoms of achalasia

Answer 5

• Progressive dysphagia (for solids and liquids)
• Weight loss
• Chest pain
• Chest infection
• Regurgitation

Question 6

Signs: XXX

Answer 6

XXX

Question 7

Investigations: What investigations can we do for achalasia? (3)

Answer 7

• Endoscopy
• Barium swallow
• Oesophageal pH monitoring with manometry (assesses motility/peristalsis)

Question 8

Treatment: What are the different categories of treatment for achalasia

(a) Pharmacological
(b) Endoscopic
(c) Surgical

Answer 8

(a) Pharmacological treatment includes calcium channel blockers and nitrates to both relax to LOS

(b) - Botulinum toxin injection into the muscle of the LOS
- Pneumatic balloon dilation

(c) Myotomy (cutting muscles of the cardia to allow foods and liquids to pass to the stomach)

Question 9

Complications: What are the complications of achalasia?

Answer 9

• Aspiration pneumonia and lung disease

- Increased risk of squamous cell oesophageal carcinoma