achalasia Flashcards
define achalasia?
Failure of the oesophageal peristalsis and of relaxation of the lower oesophageal sphincter due to degenerative loss of ganglia from Auerbach’s plexus.
what is the aetiology of achalasia?
degeneration of the ganglion cells of the myenteric plexus in the oesophagus due to unknown cause
similar disease to achalasia?
CHAGAS DISEASE - this is an oesophageal infection with Trypanosoma cruzi seen in Central/South America
epidemiology of achalasia?
presents in middle age
presenting symptoms of achalasia?
INSIDIOUS onset and gradual progression • Dysphagia involving BOTH solids and liquids • Difficulty belching • Regurgitation o This can lead to cough, aspiration pneumonia • Heartburn • Chest pain • Weight loss • Halitosis
signs of achalasia on physical examination?
• May show signs of complications:
o Aspiration pneumonia
o Malnutrition
o Weight loss
investigations for achalasia?
- CXR
- Barium swallow
- Endoscopy
- Manometry
what might the CXR show>
o Widened mediastinum
o Double right heart border
o Air-fluid level in the upper chest
o Absence of the normal gastric air bubble
what might the barium swallow show?
o Dilated oesophagus which smoothly tapers down
o Birds beak appearance
what might the endoscopy rule out?
excludes malignancy
what might the manometry show?
o Elevated resting LOS pressure (> 45 mm Hg)
what antibodies are present in chugs disease?
antibodies against T. cruzi
