Achalasia

Question 1

Define achalasia

Answer 1

Primary motor disorder of aperistalsis and insufficient LOS relaxation in response to swallow

Question 2

Aetiology of achalasia

Answer 2

• The LOS is hypertensive in half of patients
• Inflammatory destruction of inhibitory nitrinergic (ganglion) neurons in the oesophageal myenteric plexus
Can have infective, autoimmune or genetic triggers

Question 3

RFs of achalasia

Answer 3

•	Allgrove syndrome = triple A syndrome
o	Achalasia, Addisonianism and Alacrima (absence of tear secretion)
o	Rare autosomal recessive
•	Herpes/measles viruses
•	Autoimmune
•	HLA class-II antigens
•	Consanguineous parents

Question 4

Presenting symptoms of achalasia

Answer 4

•	Dysphagia*
•	Regurgitation*
•	Retrosternal pain*/ heart burn
o	Relieved by cold water
•	Weight loss*
•	Hiccups
•	Recurrent chest infections
•	Globus (sensation of lump in throat)

Question 5

Signs of achalasia

Answer 5

• Posturing (adopt certain postures) -> aid swallowing

* Coughing upon swallowing

Question 6

Investigations for achalasia

Answer 6

1. Upper GI endoscopy - mucosa obscured by retained saliva, frothy appearance. If advanced - dilated, torturous oesophagus w/ food debris
2. Barium swallow - loss of peristalsis, delayed opening, beak-like narrowing of oesophagus
3. Oesophageal manomatery- shows high resting pressure of lower oesophagus, incomplete relaxation of LOS

Question 7

Tx of achalasia

Answer 7

nifedipine (CCB) for relaxation

Botox to paralyse