Achalasia Flashcards
Define Achalasia?
A condition in which the normal muscular activity of the oeseophagus is disturbed (absent or uncoodinated) due to failure or Incomplete relaxation of the lower oesophageal sphincter
What happens because of Achalasia?
This leads to delay in the passage of swallowed material into the stomach
What is the aetiology of Achalasia?
It is caused by degeneration of the ganglion cells of the myenteric plexus in the oesophagus due to an unknown cause
What is Chagas Disease?
Similar condition caused by oesophageal infection with Trypanosoma cruzi seen in Central/South America
What is the epidemiology of Achalasia?
It may occur at any age (mainly 25-60 yrs)
Affects both sexes equally
Annual Incidence: 1/100,000
What is the onset of Achalasia?
Insidious Onset and gradual progression
What are the presenting symptoms of Achalasia?
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)
What are the signs of Achalasia on physical examination?
May show signs of complications:
- Aspiration Pneumonia
- Malnutrition
- Weight Loss
What investigations would you do for Achalasia?
CXR
Barium Swallow
Endoscopy
Manometry
What might you see on a CXR for Achalasia?
Widened Mediastinum
Double right heart border (dilated oesophagus)
Air-fluid level in the upper chest
Absence of the normal gastric air bubble
What might a barium swallow show for Achalasia?
Dilated oesophagus which smoothly tapers down to the sphincter (beak-shaped)
Why would you do an Endoscopy for Achalasia?
To exclude malignancy (which could mimic Achalasia)
Why do we do Manometry for Achalasia?
Used to assess pressure at the LOS (Lower Oesophageal Sphincter)
What might we see on a Manometry for Achalasia?
Elevated resting LOS pressure (> 45 mm Hg)
Incomplete LOS relaxation
Absence of peristalsis in the smooth muscle portion of the oesophagus
What else can we do for Achalasia?
You may do serology for antibodies against T.cruzi if Chagas Disease is a possibility (and blood film may detect parasites)
