Oesophageal Achalasia

Question 1

Pathophysiology of oesophageal achalasia

Answer 1

Lack of inhibitory ganglion cells, causing incomplete lower oesophageal sphincter relaxation

Question 2

Causes of oesophageal achalasia (3)

Answer 2

1. Primary (autoimmune + viral triggers)
2. Cancer
3. Chagas disease

Question 3

Symptoms of oesophageal achalasia

4

Answer 3

1. Dysphagia
2. Regurgitation
3. Weight loss
4. Chest pain

Question 4

Differentials for oesophageal achalasia

6

Answer 4

1. GORD
2. Hiatus hernia
3. Fibrosis
4. Oesophageal cancer
5. IHD
6. Psychosomatic

Question 5

Investigations for oesophageal achalasia

3

Answer 5

1. Manometry
2. Barium swallow (bird’s beak/rat’s tail)
3. Endoscopy

Question 6

Management of achalasia

Answer 6

1. Lifestyle: eat slowly, chew well, water
2. Medical: sublingual nifedipine, PPIs, botox injection
3. Surgical: pneumatic dilatation, Heller myotomy

Question 7

Major complication of achalasia

Answer 7

Aspiration of food and saliva