Achalasia

Question 1

what is the cause of achalasia?

Answer 1

degeneration of the myenteric plexus with loss of normal inhibitory neural structure of the lower esophageal sphincter (LES).

Question 2

what is the etiology of vast majority of Achalisa cases?

Answer 2

unknown etiology.

Question 3

What is the Clinical Presentation of Achalasia?

Answer 3

1-progressive dysphagia to both solids and
liquids simultaneously
2-regurgitation several hours after eating
3-esophageal dysphagia with weight loss
4-no relationship with alcohol or tobacco use

Question 4

What is the Clinical Presentation of esophageal cancer?

Answer 4

1-difficulty swallowing liquids not solid foods
2-difficulty swallowing liquids
3-more common in older patients with a long history of alcohol and tobacco use.

Question 5

what is the diagnosis of Achalasia?

Answer 5

1-Heme-positive stools.
2- >6-month duration of symptoms.
3-weight loss will confirm diagnosis.
4-Barium esophagography is very accurate
5-  esophageal manometry is the most accurate test overall (gold standard)

Question 6

what is the order of the Diagnostic evaluation?

Answer 6

1- Barium swallow
2- Esophageal manometry
3- Upper endoscopy

Question 7

What is the Treatment of Achalasia?

Answer 7

1-best initial therapy is pneumatic dilation or laparoscopic surgical myotomy
2-Pneumatic dilation effective in 80–85% of patients, with 3–5% risk of perforation
3-Botulinum toxin injections into the LES is second-line treatment.
4-Calcium channel blockers and nitrates are third-line treatment