GI Dismotility Disorders

Question 1

What is the primary defect in achalasia?

Answer 1

Failure of LES to relax upon swallowing

Question 2

What are some micropathological findings of achalasia?

Answer 2

Lymphocytic infiltrate in myenteric plexus

Loss of post-ganglionic inhibitor neurons

Question 3

What are some clinical findings of achalasia?

Answer 3

Dysphagia
Weight loss
Chest pain near xiphoid process
Heartburn

Question 4

What is the pathognomonic radiography finding of achalasia?

Answer 4

Dilated esophagus

Question 5

What is the barium finding of achalasia?

Answer 5

Dilated esophagus with bird-beak appearance

Question 6

What are the diagnostic criteria on manometry for achalasia?

Answer 6

2-fold:
LES failure to relax
Aperistalsis in esophageal body

Question 7

What are the two best treatment options for achalasia?

Answer 7

Balloon dilation

Heller’s Myotomy

Question 8

Untreated achalasia increases risk for __

Answer 8

SCC of esophagus

Question 9

What are some diseases similar to achalasia?

Answer 9

Chagas, malignancy (gastric carcinoma)

Question 10

What does manometry show for diffuse esophageal spasm?

Answer 10

repetitive contractions of prolonged duration (multiple peaks)

Question 11

What does manometry show for nutcracker esophagus?

Answer 11

Increased distal peristaltic amplitude and duration as you go down