Achalasia + Oesophageal Cancer

Question 1

Symptoms of achalasia?

Answer 1

Dysphagia - solids and liquids
Regurgitation
Dyspepsia
Weight loss

Question 2

Aetiology of achalasia?

Answer 2

• Absence of oesophageal peristalsis
• Failure of lower oesophageal sphincter to relax (smooth muscle too contracted)
  (reverse GORD, lower oesophageal spincter too open in GORD, too closed in achalasia)

Question 3

Appearance of achalasia on barium swallow?

Answer 3

Bird’s beak appearance

Question 4

Main differences between oesophageal cancer and achalasia?

Answer 4

Oesophageal cancer progresses from solids to liquids + red flags (FLAWS) with endoscopy the first line investigation

Achalasia is intermittent solids + liquids + no red flags with barium swallow as first line investigations + manometry

Question 5

What is Plummer-Vinson syndrome?

Answer 5

Oesophageal webs (causing dysphagia) + iron-deficiency anaemia

Question 6

What is a pharyngeal pouch?

Answer 6

Pouch in pharynx, often get halitosis from food getting stuck and broken down in pouch (visible on barium swallow)

Question 7

Clues of a neurological cause of dysphagia?

Answer 7

Coughing (immediately on swallow)
Choking (implies problem with swallow process

Others

• slow eating
• early dysphagia for liquids (functional problem)

Cranial nerve pathology suggests bulbar palsy (MND)

Question 8

What are the 2 main neurological diseases that can cause dysphagia?

Answer 8

Stroke

Parkinson’s

Question 9

Other causes of dysphagia?

Answer 9

CREST (limited cutaneous scleroderma, covered in Rheum)

Oesophageal spasm (‘corkscrew oesophagus’ appearance on barium swallow)

Question 10

What does a ‘corkscrew oesophagus’ on barium swallow indicate?

Answer 10

Oesophageal spasm (non-peristaltic contraction of oesophagus)