Diseases of the esophagus Flashcards
Cause of achalasia
loss of ganglion cells in myenteric plexus
Usual age of presentation of achalasia
btw 25 and 50
Pathophysiology of achalasia
autoimmune process
latent herpes simplex 1 infection
Effect of long standing achalasia
sigmoid deformity of esophagus
Hypertrophy of LES
Symptoms of achalasia
Dysphagia
regurgitation
chest pain
weight loss
dysphagia in achalasia
Both solid and liquid food dysphagia
Complications of advanced achalasia
bronchitis
pneumonia
lung abscess
SCC of lower oesophagus
Symptom that is frequent early in course of achalasia
chest pain due to oesophageal spasm
Symptom relief following treatment of achalasia
Chest pain does not decrease much
Dysphagia or regurgitation is relieved
DD for achalasia
chagas
DES
pseudoachalasia
protozoa and vector of chagas disease
Trypanasoma cruzi
reduvid or kissing bug
Causes of pseudoachalasia
carcinoma of gastric fundus or lower esophagus
paraneoplastic syndrome
Presentation of pseudoachalasia
abrupt onset of symptoms(<1 year)
advanced age
weight loss
Workup for pseudoachalasia
OGD
CT
EUSG
role of endoscopy in achalasia
exclusion of pseudoachalasia
Diagnosis of achalasia cardia
barium swallow x ray
esophageal manometry
Diagnostic criteria for achalasia in esophageal manometry
absent peristalsis
impaired LES relaxation
Most sensitive diagnostic test for achalasia
esophageal manometry
Subtypes of achalasia
classic achalasia
achalasia with compression
spastic achalasia
Drug therapy in achalasia
Nitrates
CCB
Botulinium toxin
sildinafil
Botulinium toxin injection in achalasia
Improves dysphagia in atleast 66% of patients for 6 months
Only durable therapies for achalasia
Pneumatic dilatation
Heller myotomy
In achalasia Rx,Balloon is dilated to ______ cm
3-4
Major complication of balloon dilatation
perforation
