Achalasia

Question 1

Achalasia

Answer 1

Disorder of theoesophagus, where the LOS fails to relax (open) properly, and therefore food is not able to pass into the stomach - as a result the food is stuck in the oesophagus, and often brought back up. Some people can even vomit upon drinking water.

Question 2

Achalasia Aetiology

Answer 2

Idiopathic

Question 3

Achalasia Complication

Answer 3

Aspiration Pneumonia

Risk of squamous cell oesophageal carcinoma

Question 4

Achalasia

Symptoms:

Answer 4

Regurgitation
Progressive dysphagia for solids and liquids
Vomiting
Chest Pain, Chest Infection
Weight Loss.

Question 5

Achalasia Investigations:

Answer 5

Manometry (excess LOS tone; most important diagnostic test)
- Barium Swallow (dilated tapering oesophagus, bird beak appearance) - CXR = fluid level in dilated oesophagus (arrow) -eg. above the heart

Question 6

Achalasia Treatment:

Answer 6

Myotomy (surgical)
- Heller Cardiomyotomy (First line in patients suitable for surgery)

Nitrates (pharmacological)
Calcium Channel Blockers (pharmacological)

Botulinum Toxic Pneumatic Balloon Dilation (endoscopic)
Pneumatic Balloon Dilation (radiological).