Achalasia Flashcards
Define achalasia
Condition where normal muscular activity of oesophagus is disturbed (absent or uncoordinated) due to failure/incomplete relaxation of the lower oesophageal sphincter
Aetiology of achalasia
Caused by degeneration of the ganglion cells of the myenteric plexus in oesophagus (due to unknown cause)
Similar disorder to achalasia
Chagas disease - caused by oesophageal infection with Trypanosoma cruzi seen in Central/South America
Epidemiology of achalasia
age & sex
Occurs at any age (but mainly 25-60 yrs)
Affects both sexes equally
Presenting symptoms of achalasia
general + 6
INSIDIOUS onset & gradual progression of:
Intermittent dysphagia involving solids & liquids
Difficulty belching
Regurgitation (particularly at night)
Heartburn
Chest pain (atypical/cramping, retrosternal)
Weight loss (eating less)
Signs of achalasia on physical examination
general + 3
May show signs of complications:
Aspiration pneumonia
Malnutrition
Weight loss
Investigations for achalasia
4 + potential
CXR
Barium swallow
Endoscopy
Manometry
Serology for antibodies against T. cruzi if Chagas disease is a possibility
Findings of investigation for achalasia - CXR
4
May show: Widened mediastinum Double right heart border Air-fluid level in upper chest Absence ofnkormal gastric air bubble
Findings of investigation for achalasia - barium swallow
1
May show:
Dilated oesophagus which smoothly tapers down to sphincter (beak shaped)
Purpose of investigation for achalasia - endoscopy
1
To exclude malignancy
Purpose & findings of investigation for achalasia - manometry
(1 + 3)
To assess pressure in LOS
May show:
Elevated resting LOS pressure (>45 mmHg)
Incomplete LOS relaxation
Absence of peristalsis in smooth muscle portion of oesophagus
