Achalasia Flashcards
Define
An oesophageal motility disorder, characterised by loss of peristalsis and failure of relaxation of the lower oesophageal sphincter
- This leads to delay in the passage of swallowed material into the stomach
Causes
Aetiology: it is caused by degeneration of the ganglion cells of the myenteric plexus in the oesophagus due to an unknown cause
Epidemiology
It may occur at any age (mainly 25-60 yrs)
Affects both sexes equally
Annual incidence 1/100,000
Symptoms
INSIDIOUS onset and gradual progression of:
- Intermittent dysphagia involving solids and liquids
- Difficulty belching
- Regurgitation (particularly at night)
- Heartburn
- Chest pain (atypical/cramping, retrosternal)
- Weight loss (because they are eating less)
Signs
May show signs of complications:
- Aspiration pneumonia
- Malnutrition
- Weight loss
Investigations
CXR may show:
- Widened mediastinum
- Double right heart border (dilated oesophagus)
- Air-fluid level in the upper chest
- Absence of the normal gastric air bubble
Barium swallow may show:
- Dilated oesophagus which smoothly tapers down to the sphincter (beak-shaped)
Endoscopy to exclude malignancy (which could mimic achalasia)
Manometry (used to assess pressure at the LOS) may show:
- Elevated resting LOS pressure (> 45 mm Hg)
- Incomplete LOS relaxation
- Absence of peristalsis in the smooth muscle portion of the oesophagus
NOTE: you may do serology for antibodies against T. cruzi if CHAGAS DISEASE is a possibility (and blood film may detect parasites)
