Achlasia Flashcards
What is achalasia?
Disturbance of normal muscular activity of oesophagus (absent or uncoordinated) due to FAILURE or INCOMPLETE RELAXATION of LOS
Causes delay in passage of swallowed material into stomach
Describe the aetiology of achalasia?
Degeneration of ganglion cells of myenteric plexus in oesophagus (unknown cause)
Describe the epidemiology of achalasia
Any age (mainly 25-60 yrs) M = F Annual incidence 1/100,000
Describe the onset of achalasia
INSIDIOUS onset + gradual progression of sx
List 6 symptoms of achalasia
Intermittent dysphagia of solids + liquids
Difficulty belching
Regurgitation (esp. at night)
Heartburn
Chest pain (atypical/ cramping, retrosternal)
Globus sensation
List 3 signs of achalasia
Signs of complications:
Aspiration pneumonia
Malnutrition
Weight loss (eating less)
What may be seen on CXR in achalasia ?
Dilated oesophagus with air-fluid level
Absence of normal gastric air bubble
What may be seen on barium swallow in achalasia?
Dilated oesophagus which smoothly tapers down to the sphincter (beak-shaped)
What investigations are performed in achalasia?
CXR
Barium Swallow
Endoscopy to exclude malignancy
Manometry (assess pressure at LOS)
What may be seen on manometry in achalasia?
Elevated resting LOS pressure (> 45mmHg)
Incomplete LOS relaxation
Absence of peristalsis in the smooth muscle portion of the oesophagus
What may you perform to exclude Chagas disease when considering achalasia?
Serology for antibodies against T. cruzi
Blood film to detect parasites
What disease presents with similar symptoms to Achalasia with achalasia and myocarditis?
CHAGAS DISEASE: Oesophageal infection with Trypanosoma cruzi seen in Central/ S. America