Achlasia

Question 1

What is achalasia?

Answer 1

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

Question 2

Describe the aetiology of achalasia?

Answer 2

Degeneration of ganglion cells of myenteric plexus in oesophagus (unknown cause)

Question 3

Describe the epidemiology of achalasia

Answer 3

Any age (mainly 25-60 yrs)  
M = F
Annual incidence 1/100,000

Question 4

Describe the onset of achalasia

Answer 4

INSIDIOUS onset + gradual progression of sx

Question 5

List 6 symptoms of achalasia

Answer 5

Intermittent dysphagia of solids + liquids
Difficulty belching
Regurgitation (esp. at night)
Heartburn
Chest pain (atypical/ cramping, retrosternal)
Globus sensation

Question 6

List 3 signs of achalasia

Answer 6

Signs of complications:
Aspiration pneumonia
Malnutrition
Weight loss (eating less)

Question 7

What may be seen on CXR in achalasia ?

Answer 7

Dilated oesophagus with air-fluid level

Absence of normal gastric air bubble

Question 8

What may be seen on barium swallow in achalasia?

Answer 8

Dilated oesophagus which smoothly tapers down to the sphincter (beak-shaped)

Question 9

What investigations are performed in achalasia?

Answer 9

CXR
Barium Swallow
Endoscopy to exclude malignancy
Manometry (assess pressure at LOS)

Question 10

What may be seen on manometry in achalasia?

Answer 10

Elevated resting LOS pressure (> 45mmHg)
Incomplete LOS relaxation
Absence of peristalsis in the smooth muscle portion of the oesophagus

Question 11

What may you perform to exclude Chagas disease when considering achalasia?

Answer 11

Serology for antibodies against T. cruzi

Blood film to detect parasites

Question 12

What disease presents with similar symptoms to Achalasia with achalasia and myocarditis?

Answer 12

CHAGAS DISEASE: Oesophageal infection with Trypanosoma cruzi seen in Central/ S. America