Achalasia

Question 1

Define Achalasia

Answer 1

Oesophagal motor disorder -loss of peristalsis and insufficient dilation of the lower oesophagus after swallowing
=> food stuck in the oesophagus

Question 2

Aetiology and risk factors of Achalasia

Answer 2

Inflam destruction of nitrigenic reflex neutrons–aetiology unclear
possibly infection, autoimmune and familial (genetic)

Risk factors:
Age (median 53)
Higher is western world

Allgrove syndrome (Achalasia is one of 3 cardinal signs)

Herpes, measles
Incest
other autoimmune disease

Question 3

Epidiemology of Achalasia

Answer 3

3 in 100000 in western world-
0.3 in africa

any age but more with age
no sex difference

Question 4

Signs and symptoms of achalasia

Answer 4

Key: difficulty swallowing liquids and solids
(solids> liquids. Liquids tend to be more advanced)

Posturing to aid swallowing (arc shoulder, lift arms,
Retrosternal Pain-precipated by swallowing
Regurgitation-Later part of disease where oesophagus dilates–reflux is bland (not acidic)
Gradual weight loss-cant swallow
Sensation of lump in throat

aspiration pneumonia

Question 5

Investigations of Achalasia

Answer 5

Any dysphagia needs investigation
OGD-just see the blockage
Barium swallowing + Fluoroscopy-dilated oesophagus with beak shaped bottom
CT chest-dilated oesophagus