Barium swallow and endoscopy

Question 1

describe bird beak image and endoscopy image (slide 6)

Answer 1

bird beak: barium swallow depicting dilation of the proximal esophagus with classic bird beak sign seen with pts who have achalasia

endoscopy: endoscopy of the esophagus showing stagnant food and fluid

Question 2

how do patients with achalasia present

Answer 2

dysphagia to solid and liquids, weight loss, chest pain, regurg

Question 3

differentials for bird beak sign/ stagnant food and fluid on endoscopy of esophagus

Answer 3

chagas disease (life threatening)
cricopharyngeal spasm
diffuse esophageal spasm

Question 4

what other investigations would u want to do in a patient with achalasia

Answer 4

esophageal mamometry- measure the lower esophageal sphincter pressure (>60mmhg in achalasia)

Barium swallow showing-smooth filling defect at LES with dilated and tortuous esophagus

endoscopy: r/o pseudoachalasia

CXR: shows mediastinal widening with dilated esophagus, air/fluid level and absence of gastric bubble

Question 5

treatment of achalasia

Answer 5

baloon dilation -inflation of endoscopic baloon done under u/s guidance inflation to 300mmhg in 3 mins

helller’s cardiomyotomy -divides muscles of LE and upper stomach down to mucosa

endoscopic injection of botulinum toxin-paralize LES

Question 6

long term complications of achalasia

Answer 6

esophageal perforation

aspiration oneumonia

SCC