Achlasia

Question 1

Definition

Answer 1

Lower oesophageal sphincter fails to relax

Due to degeneration of the myenteric plexus / auerbach’s plexus

Question 2

Causes

Answer 2

Idiopathic

Chagas disease

Question 3

Clinical features

Answer 3

Dysphagia: liquids and solids, intermittent but can be progressive

Regurgitation especially at night

Substerna, cramps or pressure due to LOS not relaxing. This can be relieved by drinking through the pain or cold water

Question 4

Complications

Answer 4

Squamous cell carcinoma if chronic

Question 5

Investigations

Gold standard?

Answer 5

Bloods: FBC, electrolytes.g. Magnesium, calcium and phosphate because risk of refeeding risk

Imaging:
Gold standard is oesophageal MANOMETRY (showing high resting pressure of lower oesophageal sphincter and lack of peristalsis)
Barium swallow - bird beak
OGD endoscopy

Question 6

Management

What is the definitive treatment?

Answer 6

Conservative is minimal

Medical: CCB, nitrates

Interventional:
Botox injections to LOS
Endoscopic balloon dilatation (definitive management- tends to be in older patients)
Hellers cardiomyotomy (tends to be in younger patients)