Achalasia

Question 1

Define:

Answer 1

A condition where normal esophageal muscular activity is disturbed (absent or uncoordinated) due to failure of the lower oesophageal sphincter.

This means there is a delay between the time the food is swallowed and it reaches the stomach.

Presents very similarly to Chagas disease

Question 2

Aetiology/risk factors:

Answer 2

Degeneration of the ganglion cells of the myenteric plexus in the oesophagus for an unknown reasons (could be autoimmune or infection)

RF - Allgrove syndrome

Question 3

Epidemiology:

Answer 3

1/100,000 incidence
Affects all ages but mainly 25-60 year olds
Equal incidence in both genders

Question 4

Symptoms:

Answer 4

Insidious onset and gradual progression:

Intermittent dysphagia with fluids and solids
Chest pain
Heart burn
Regurgitation (particularly at night)
Weight loss 
Difficulty belching

Question 5

Signs:

Answer 5

There may be signs of complications:
Aspiration pneumonia
Weight loss
Malnutrition

Question 6

Investigations:

Answer 6

Barium swallow:
-dilated oesophagus tapering to the sphincter - BIRD BEAK APPEARANCE.

Manometery:
Looks at pressure in the LOS
-There will be elevated pressure on the LOS (>45mmHg)
- Incomplete relaxation of LOS
-Absence of peristalsis in the smooth muscle portion of the oesophagus

CXR:

• widened mediastinum
• Dilated oesophagus (double right heart border)
• Absence of normal gastric bubble
• -Air-fluid level in upper chest

Endoscopy to rule out malignancy

Serology if you suspect Chagas disease for T.Cruzi