Achalasia

Question 1

What is achalasia?

Answer 1

• Oesophageal motility disorder characterised by aperistalsis and LOS dysfunction

Question 2

Outline the likely pathogenesis of achalasia

Answer 2

• Inflammatory destruction of inhibitory nitrinergic neurons in the oesophageal myenteric plexus
  
  • Inflammatory/autoimmune/genetic factors are postulated as causes

Question 3

What are the likely findings on history in a patient with achalasia?

Answer 3

• Dysphagia to solids and liquids
• Posturing to aid swallowing
• Retrosternal pressure/pain
• Regurgitation
• Gradual and mild weight loss

Question 4

How would you investigate a patient that you thought had achalasia?

Answer 4

• Upper GI endoscopy
• Barium swallow

Question 5

What are the managment principles for treating achalasia?

Answer 5

• Medical intervention
  
  • Isosorbide dinitrate or verapamil
• Surgical intervention
  
  • Pneumatic dilation or laparoscopic cardiomyotomy (LOS split and full wrap created around)