Achalasia - Upper GI Flashcards
What is achalasia?
Oesophageal aperistalsis + failure of relaxation of the lower oesophageal sphincter
What factor predisposes 1/2 of patients to achalasia?
elevated lower oesophageal pressure
What is the epidemiology of achalasia?
- incidence = 1:100,000
- males = females
- rare in childhood
What is the aetiology of achalasia?
- unknown
- ?autoimmune
- ?neurodegenerative
- ?viral
failure of relaxation of the lower oesophageal sphincter:
- Loss of inhibitory nitrinergic neurons in the oesophageal myenteric plexus.
What are the risk factors of achalasia?
Infections:
- herpes
- measles
Immunity
- autoimmunity
- HLA class II antigens
Genetics
- consanguinity
- Allgrove syndrome - also alacrima + adrenal insufficiency
What are the presenting symptoms of achalasia?
long Hx of:
- intermittent dysphagia - liquids + solids
- regurgitation
- spontaneous retrosternal pain
- due to oesphageal spasm - can be misdiagnosed as cardiac pain
note: weight loss is minimal
Atypical:
- nocturnal cough
- recurrent chest infections
- globus sensation.
What signs are observed on physical examination of a patient with suspected achalasia?
no physical signs on examination
What condition is a possible complication of regurgitation secondary to achalasia?
Aspiration pneumonia
What is the primary investigation for suspected achalasia?
-
Upper GI endoscopy
- to exclude malignancy
-
Barium swallow w fluoroscopy
- findings: dilated oesophageous torturous in advanced disease
- Oesophageal manometry (catheterisation)
What are some other possible investigations for suspected achalasia?
- CXR
-
radionucleotide oesophageal emptying studies / timed barium oesophagogram
- measure of response to therapy ; findings: delayed oesophageal transit
-
CT chest
- to rule out gastro-oesophageal infliltration by malignancy
