Achlasia

Question 1

What is achlasia?

Answer 1

failure of lower oesophageal sphincter to relax and aperistalsis degeneration of myenteric plexus

Question 2

What does the myenteric plexus produce?

Answer 2

NO and Vasoactive intestinal peptide for relaxation

Question 3

What are RF for achlasia?

Answer 3

unknown

Question 4

What is a secondary cause of achalsia?

Answer 4

very rare and nich condition: Chagas Disease (trypansoma cruzi)

Question 5

What are symptoms of achlasia?

Answer 5

1. Dyspahagia
2. Regurgitation due to food trapped in oesophagus
3. Gradual weight loss: due to lack of food ingestion (cancer is sudden)

Question 6

What substance is the dysphagia for in achlasia?

Answer 6

sudden solids and liquids

Question 7

What is the gold standard investigation for achlasia and what will it show?

Answer 7

High resolution oesophageal manometry: demonstrate incomplete relaxation and aperistalsis

Question 8

What other investigations are done and why for achlasia?

Answer 8

1. Upper GI endoscopy: can show retained food debris with dilated wall
2. Barium swallow: birds break appearance

Question 9

What is the medical therapy of achlasia?

Answer 9

CCBs and nitrates

Question 10

What is the surgical repair for achlasia?

Answer 10

heller cardiomyotomy

Question 11

What are possible complications of achlasia?

Answer 11

1. Aspiration pneumonia
2. GORD
3. Oesophageal cancer