Upper GI

Question 1

In achalasia, is swallowing liquids or foods harder initially?

Answer 1

Swallowing liquids is harder initially

Question 2

Achalasia is most commonly seen in which age groups?

Answer 2

Young adults (idiopathic) and old age (degeneration)

Question 3

Which age group is diffuse oesophageal spasm most common in?

Answer 3

Young adults

Question 4

Characterised by acute pain along the length of the oesophagus induced by ingestion, especially of hot or cold substances

Answer 4

Diffuse oesophageal spasm

Question 5

What is achalasia?

Answer 5

When the lower oesophageal sphincter fails to open properly

• results in slow progressive dysphagia
• frequent regurgitation of food is common late in the disease
• Secondary recurrent respiratory infections due to aspiration

Question 6

“rat’s tail” on barium swallow

Answer 6

achalasia

Question 7

“bird’s beak” on barium swallow

Answer 7

achalasia

Question 8

“corkscrew” appearance on barium swallow

Answer 8

Diffuse oesophageal spasm

Question 9

Treatment for diffuse oesophageal spasm

Answer 9

Oral calcium channel blockers or relaxants (e.g. benzodiazepines)
Long-acting nitric oxide donors (smooth muscle relaxant)
Widespread oesophageal pneumatic dilatations (often repeated)
Long surgical open myotomy - rarely undertaken